Table 1.

Key information from this review

What makes medical honey effective?	Medical honey is hygroscopic, meaning it draws moisture out of the environment and thus dehydrates bacteria. The enzyme glucose oxidase, produces gluconic acid and minute amounts of hydrogen peroxide when in contact with the wound surface. In addition, each charge contains light- and heat-stable, in vitro confirmed antibacterial properties from Leptospermum spp. honeys. The pH level of honey is low (mean 4.4). Bacterial colonization or infection and recalcitrant wound healing situations are often accompanied by high pH values in wound exudates and lowering the pH speeds healing.
Why is medical honey irradiated?	Honey may contain spores from Clostridium botulinum, which are inactivated. The ready to use product is delivered sterile.
What is Medihoney™?	Medihoney is a mixture of two honeys derived from Australia and New Zealand containing glucose oxidase and Leptospermum compounds which contribute to its antibacterial activity.
Legal background	Medihoney™ is licensed for wound care in Australia, Europe and the USA. In Europe a CE-certification exists declaring Medihoney™ as medical product.
Practical advances	Medical honey dressings are easy to change without pain and without harm to the regenerating tissue. Malodour from recalcitrant wounds as a result of critical colonization and partial tissue necrosis is successfully abandoned with medical honey due to its antibacterial, anti-inflammatory and debriding effects. Medical honey can be used in all different stages of wound healing, in many different types of wounds and even in patients with diabetes. Medical honey is well accepted by most patients and their families.
Drawbacks	Some patients (5 out of 100) experience pain after the application of medical honey to the wound. In some of them, treatment with medical honey has to be stopped. Few patients with pre-existing atopic diseases show local atopic reactions. No severe systemic atopic reaction due to medical honey has been reported in the literature. Medical honey has to be kept in the wound for 12–24 h a day. Thus, it is combined with particular dressings like calcium alginates of hydrofiber dressings, which add substantially to the overall cost of treatment. Depending on the amount of exudate, the dressing with medical honey has to be changed up to 2 times a day in acute inflammatory wounds. The most often practised change interval for medical honey dressings is every 24–48 h.
Scientific evidence#	For Medihoney™: one prospectively randomized controlled study considering the prevention of catheter-related bacteremias in patients with dialysis catheters. Many in vitro studies and animal studies confirming the antibacterial properties and the positive effects on wound healing. Growing body of clinical experiences and observational studies derived from independent wound care facilities all over the world.

#For the medical use of honey in general please refer to the outstanding review of Peter Molan from 2006 (15)