March 2006

Dear Readers Here's the Article for this Month:

Wound care with antibacterial honey (Medihoney)
in pediatric haematology-oncology

Author(s): Simon A, Sofka K, Wiszniewsky G, Blaser G, Bode U, Fleischhack G
Journal: Support Care Cancer 2006; 14: 9

For paediatric patients treated with chemotherapy, the healing of wounds is often prolonged and altered for various reasons related to immunosuppression, infections, and malnutrition due to gastrointestinal symptoms such as anorexia and painful oral mucositis. Among the most common wounds in oncological paediatric patients are decubitus ulcers, dehiscence and infection of surgical wounds, inflammation or infection at catheter entry sites, and wounds following reservoir explantation, etc.

The authors review the literature on the use of non-heated honey which has proven antibacterial activity (available in Australia and New Zealand) on infection, and they have also reviewed the experience using Medihoney™ in wound care in the Department of Paediatric Haematology and Oncology, Children’s Hospital, Medical Centre, University of Bonn.

Medihoney™ (http://www.medihoney.com) is a standard mixture of honeys that has been sterilized, but not inactivated through irradiation with the aim to inactivate Clostridium spores. Medihoney™ is available and certified by the European Union as a medical device type IIb for wound care. It is available as 100% honey or honey gel 80%. The treatment with antibacterial honey is low cost, a well accepted treatment by patients, and may rarely cause pain locally.

Various authors have reported the efficacy of non-heated honey in the treatment of infected wounds, ulcers, dermatitis, herpetic lesion, burns and scalds as well as for protection of transplants in plastic surgery. The honey’s antibacterial activity has been shown againstnosocomial bacterial such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) and pseudomonas spp.

German authors have described the use of Medihoney™ in patients with dehiscent or infected surgical wounds, peridrainage sites, after explantation of an infected port reservoir, in surgical wounds in immunosuppressed patients, in patients with necrotic skin lesions, after chemotherapy extravasation, in superinfected skin lesions, and in children with eczemas or herpetic lesions. The authors recommend the daily use of the Medihoney™ gel in catheter entry sites to prevent infections.

The authors describe their experience in 15 exemplary wound care situations in paediatric oncology patients successfully managed with Medihoney™ such as tumoural infection (s.aureus); ecthyma gangraenosus (p.aeruginosa); dehiscent suture or infection of the port pocket (CoNS); dehiscent thoracotomy wound or drainage wound; drainage wounds infected with MRSA; infected entrance of the Broviac CVAD; abscess (s. aureus) wound care after surgical drainage; and dehiscent amputation wounds after postoperative chemotherapy with adriamycin. In all situations the use of Medihoney™ for 5 to 72 days with or without the use of systemic antibiotics (often used for a very short period of time before or during honey therapy in patients with severe neutropenia) resulted in sterile wound healing sometimes despite severe immunosuppression.

How is Medihoney™ used? 1. in a rinse containing sterile Ringer’s solution to clean a wound; 2. in sterile compresses; 3. as a layer of honey to completely cover a wound and the inflamed area around it; 4. in a wound treated with sterile gauze and a tape dressing; 5. as a repeat daily medication.

Why I Chose this article

This is an important publication and also the first on the use of Medihoney™ in paediatric oncology patients. For children already under strain due to surgery, chemotherapy and the consequences of wound dehiscence or infection, it is also important to be able apply a non invasive and efficient treatment that is more humane and uses natural products that we hope to see more of in the future. We are aware, however, that controlled clinical trials comparing the use of Medihoney™ with conventional wound care therapy are definitely necessary.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC

Please visit the following link to read past Articles Of The Month:
http://www.hospicecare.com/AOM/