Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study

• Published in: Injury 2022-02, Vol.53 (2), p.381-392
• Main Authors: Muhrbeck, Måns, Wladis, Andreas, Lampi, Maria, Andersson, Peter, Junker, Johan P.E.
• Format: Article
• Language: English
• Subjects: Animals; Anti-Bacterial Agents; Antibiotics; Armed conflicts; Developing countries; Experimental animal model; Gentamicins; Honey; Penetrating wounds; Pilot Projects; Staphylococcus aureus; Swine; Wound Healing; Wound infection; Wound Infection - drug therapy
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2021.10.019

•In armed conflicts, treatment of infected wounds constitutes a large portion of the workload. Honey could be a useful adjunct in this treatment.•Neither topically applied Manuka honey nor intramuscular gentamicin reduced S. aureus count in infected wounds in the porcine model used.•Wound area remained unchanged following treatment with topically applied Manuka but decreased with intramuscular gentamicin.•Systemic and local inflammatory responses were more persistent with topically applied Manuka honey than with intramuscular gentamicin. In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 – 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0–67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p