References

Järbrink K, Ni G, Sönnergren H The humanistic and economic burden of chronic wounds: a protocol for a systematic review. Syst Rev. 2017; 6:(1) https://doi.org/10.1186/s13643-016-0400-8

World Health Organization. 2010. https://apps.who.int/iris/handle/10665/44279 (accessed 3 Jan 2021)

Sen CK, Gordillo GM, Roy S Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 2009; 17:(6)763-771 https://doi.org/10.1111/j.1524-475X.2009.00543.x

McCosker L, Tulleners R, Cheng Q Chronic wounds in Australia: a systematic review of key epidemiological and clinical parameters. Int Wound J. 2019; 16:(1)84-95 https://doi.org/10.1111/iwj.12996

Posnett J, Gottrup F, Lundgren H, Saal G The resource impact of wounds on health-care providers in Europe. J Wound Care. 2009; 18:(4)154-161 https://doi.org/10.12968/jowc.2009.18.4.41607

Fu X, Sheng Z, Cherry GW, Li Q Epidemiological study of chronic dermal ulcers in China. Wound Repair Regen. 1998; 6:(1)21-27 https://doi.org/10.1046/j.1524-475X.1998.60105.x

Allegranzi B, Zayed B, Bischoff P New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016; 16:(12)e288-e303 https://doi.org/10.1016/S1473-3099(16)30402-9

O'Meara S, Cullum N, Majid M, Sheldon T Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assess. 2000; 4:(21)1-237

Bigliardi PL, Alsagoff SA, El-Kafrawi HY Povidone iodine in wound healing: A review of current concepts and practices. Int J Surg. 2017; 44:260-268 https://doi.org/10.1016/j.ijsu.2017.06.073

Kanagalingam J, Feliciano R, Hah JH Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections. Int J Clin Pract. 2015; 69:(11)1247-1256 https://doi.org/10.1111/ijcp.12707

Mertz PM, Marshall DA, Kuglar MA Povidone-iodine in polyethylene oxide hydrogel dressing: effect on multiplication of Staphylococcus aureus in partial-thickness wounds. Arch Dermatol. 1986; 122:(10)1133-1138 https://doi.org/10.1001/archderm.1986.01660220051013

Gocke DJ, Ponticas S, Pollack W In vitro studies of the killing of clinical isolates by povidone-iodine solutions. J Hosp Infect. 1985; 6:(Suppl A)59-66

Gatti S, Cevini C, Bruno A In vitro effectiveness of povidone-iodine on Acanthamoeba isolates from human cornea. Antimicrob Agents Chemother. 1998; 42:(9)2232-2234 https://doi.org/10.1128/AAC.42.9.2232

Panda A, Ahuja R, Biswas NR Role of 0.02% polyhexamethylene biguanide and 1% povidone iodine in experimental Aspergillus keratitis. Cornea. 2003; 22:(2)138-141 https://doi.org/10.1097/00003226-200303000-00012

Kawana R, Kitamura T, Nakagomi O Inactivation of human viruses by povidone-iodine in comparison with other antiseptics. Dermatology. 1997; 195:(2)29-35 https://doi.org/10.1159/000246027

Vermeulen H, Westerbos SJ, Ubbink DT Benefit and harm of iodine in wound care: a systematic review. J Hosp Infect. 2010; 76:(3)191-199 https://doi.org/10.1016/j.jhin.2010.04.026

LeBlanc K, Campbell KE, Wood E, Beeckman D Best practice recommendations for prevention and management of skin tears in aged skin. J Wound Ostomy Continence Nurs. 2018; 45:(6)540-542 https://doi.org/10.1097/WON.0000000000000481

Zamora JL Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions. Am J Surg. 1986; 151:(3)400-406 https://doi.org/10.1016/0002-9610(86)90477-0

Nobukuni K, Hayakawa N, Namba R The influence of long-term treatment with povidone-iodine on thyroid function. Dermatology. 1997; 195:69-72 https://doi.org/10.1159/000246034

Vorherr H, Vorherr UF, Mehta P Vaginal absorption of povidone-iodine. JAMA. 1980; 244:(23)2628-2629 https://doi.org/10.1001/jama.1980.03310230030018

Danziger Y, Pertzelan A, Mimouni M Transient congenital hypothyroidism after topical iodine in pregnancy and lactation. Arch Dis Child. 1987; 62:(3)295-296 https://doi.org/10.1136/adc.62.3.295

Moore OA, Smith LA, Campbell F Systematic review of the use of honey as a wound dressing. BMC Complement Altern Med. 2001; 1:(1) https://doi.org/10.1186/1472-6882-1-2

Vandamme L, Heyneman A, Hoeksema H Honey in modern wound care: a systematic review. Burns. 2013; 39:(8)1514-1525 https://doi.org/10.1016/j.burns.2013.06.014

Dryden M, Lockyer G, Saeed K, Cooke J Engineered honey: in vitro antimicrobial activity of a novel topical wound care treatment. J Glob Antimicrob Resist. 2014; 2:(3)168-172 https://doi.org/10.1016/j.jgar.2014.03.006

Ceyhan N, Ugur A Investigation of in vitro antimicrobial activity of honey. Riv Biol. 2001; 94:(2)363-371

Al-Waili NS, Saloom KY Effects of topical honey on post-operative wound infections due to gram positive and gram negative bacteria following caesarean sections and hysterectomies. Eur J Med Res. 1999; 4:(3)126-130

Gulati S, Qureshi A, Srivastava A A Prospective randomized study to compare the effectiveness of honey dressing vs. povidone iodine dressing in chronic wound healing. Indian J Surg. 2014; 76:(3)193-198 https://doi.org/10.1007/s12262-012-0682-6

Samee MU, Qammar SM, Dogar MA Comparison of honey dressing with povidone-iodine dressing in infected surgical wounds. Pak J Med Health Sci. 2019; 13:(1)102-104

Yadav AK, Dwivedi S, Desai S A comparative study in between tropical honey and povidone dressing in diabetic wounds in a medical college of Northern India. Int Surg J. 2018; 5:(10) https://doi.org/10.18203/2349-2902.isj20184095

Stephen-Haynes J Evaluation of a honey-impregnated tulle dressing in primary care. Br J Community Nurs. 2004; 9:(Suppl 2)S21-S27 https://doi.org/10.12968/bjcn.2004.9.Sup2.13129

Medicinal uses and health benefits of honey: an overview. 2010. https://www.jocpr.com/abstract/medicinal-uses-and-health-benefits-of-honey-an-overview-55.html (accessed 3 Jan 2021)

Bang LM, Buntting C, Molan P The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Altern Complement Med. 2003; 9:(2)267-273 https://doi.org/10.1089/10755530360623383

Samarghandian S, Farkhondeh T, Samini F Honey and health: a review of recent clinical research. Pharmacognosy Res. 2017; 9:(2)121-127

White R The benefits of honey in wound management. Nurs Stand. 2005; 20:(10)57-64 https://doi.org/10.7748/ns.20.10.57.s57

Simon A, Traynor K, Santos K Medical honey for wound care—still the ‘latest resort’?. Evid Based Complement Alternat Med. 2009; 6:(2)165-173 https://doi.org/10.1093/ecam/nem175

Vardi A, Barzilay Z, Linder N Local application of honey for treatment of neonatal postoperative wound infection. Acta Paediatr. 1998; 87:(4)429-432 https://doi.org/10.1111/j.1651-2227.1998.tb01473.x

Shukrimi A, Sulaiman AR, Halim AY, Azril A A comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers. Med J Malaysia. 2008; 63:(1)44-46

Choudhary KN, Soni P, Singh R Comparative study of honey and betadine in chronic ulcer healing. J Evid Based Med Healthc. 2015; 2:(41)6877-6882 https://doi.org/10.18410/jebmh/2015/938

Manjula P, Rao AC, Ranjani P Effectiveness of honey versus betadine on episiotomy wound healing. i-manager's J Nurs. 2012; 2:(1)32-37 https://doi.org/10.26634/JNUR.2.1.1821

Honey vs povidone iodine following toenail surgery. 2005. https://tinyurl.com/rm89z9kz (accessed 3 Jan 2021)

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6:(7) https://doi.org/10.1371/journal.pmed.1000097

Jørgensen L, Paludan-Müller AS, Laursen DR Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev. 2016; 5:(1) https://doi.org/10.1186/s13643-016-0259-8

Sterne JA, Hernán MA, Reeves BC ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355 https://doi.org/10.1136/bmj.i4919

Assessing the risk of bias of individual studies in systematic reviews of health care interventions. 2008. http://www.ncbi.nlm.nih.gov/books/NBK91433 (accessed 3 Jan 2021)

Burns PB, Rohrich RJ, Chung KC The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011; 128:(1)305-310 https://doi.org/10.1097/PRS.0b013e318219c171

Bax L, Yu LM, Ikeda N, Moons KG A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol. 2007; 7:(1) https://doi.org/10.1186/1471-2288-7-40

Higgins JP, Thompson SG, Spiegelhalter DJ A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc. 2009; 172:(1)137-159 https://doi.org/10.1111/j.1467-985X.2008.00552.x

Rosenthal R Parametric measures of effect size.New York, NY, US: Russell Sage Foundation; 1994

Higgins JP, Thompson SG Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21:(11)1539-1558 https://doi.org/10.1002/sim.1186

Petitti DB Approaches to heterogeneity in meta-analysis. Stat Med. 2001; 20:(23)3625-3633 https://doi.org/10.1002/sim.1091

Duval S, Tweedie R Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56:(2)455-463 https://doi.org/10.1111/j.0006-341X.2000.00455.x

Agarwal S, Bhardwaj V, Singh A A control clinical trial of honey-impregnated and povidone iodine dressings in the treatment of diabetic foot ulcers among Northern Indian subjects. Indian J Sci Res. 2015; 6:7-10

Hammouri SK The role of honey in the management of diabetic foot ulcers. J Res Med Sci. 2004; 11:(2)20-22

Jan WA, Shah H, Khan M Comparison of conventional pyodine dressing with honey dressing for the treatment of wounds. J Postgrad Med Inst. 2012; 26:(4)402-407

Parimala PJ, Rani SR A comparative study on the effect of honey and povidone iodine ointment on pain, wound healing and quality of life of patients with varicose ulcer. J Med Sci Clin Res. 2014; 2:(6)1500-1509

Hussain MB Role of honey in topical and systemic bacterial infections. J Altern Complement Med. 2018; 24:(1)15-24 https://doi.org/10.1089/acm.2017.0017

2018. https://www.ncbi.nlm.nih.gov/books/NBK538361 (accessed 3 Jan 2021)

Kateel R, Adhikari P, Augustine AJ, Ullal S Topical honey for the treatment of diabetic foot ulcer: a systematic review. Complement Ther Clin Pract. 2016; 24:130-133 https://doi.org/10.1016/j.ctcp.2016.06.003

Wang C, Guo M, Zhang N, Wang G Effectiveness of honey dressing in the treatment of diabetic foot ulcers: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019; 34:123-131 https://doi.org/10.1016/j.ctcp.2018.09.004

Lazim N, Abdullah B Honey—a natural remedy for pain relief.: Academic Press; 2017 https://doi.org/10.1016/B978-0-12-805186-3.00010-2

Best practice in systematic reviews: the importance of protocols and registration. PLoS Med. 2011; 8:(2) https://doi.org/10.1371/journal.pmed.1001009

Harmon LJ, Losos JB The effect of intraspecific sample size on type I and type II error rates in comparative studies. Evolution. 2005; 59:(12)2705-2710 https://doi.org/10.1111/j.0014-3820.2005.tb00981.x

Wound healing

Wound infection

Leg ulcers

Diabetic foot ulcers

Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis

01 April 2021

Education

Abstract

Objectives:

In this review and meta-analysis, we analyse the evidence to compare the efficacy of honey and povidone iodine-based dressings on the outcome of wound healing.

Method:

A systematic literature search was performed using PRISMA guidelines in academic databases including MEDLINE, Scopus, Embase and CENTRAL. A meta-analysis was carried out to assess the effect of honey and povidone iodine-based dressings on mean healing duration, mean hospital stay duration and visual analogue scale (VAS) score of pain.

Results:

From the search, 12 manuscripts with a total of 1236 participants (mean age: 40.7±11.7 years) were included. The honey-based dressings demonstrated a medium-to-large effect in reduction of mean healing duration (Hedge's g: –0.81), length of hospital stay (–3.1) and VAS score (–1.2) as compared with the povidone iodine-based dressings. We present evidence (level 1b) in favour of using honey for improvement of wound recovery as compared with povidone iodine.

Conclusion:

This review and meta-analysis demonstrate beneficial effects of honey-based dressings over povidone iodine-based dressings for wound recovery.

Wound management is a challenge faced by medical practitioners around the world¹ and is considered a serious public health concern across all age groups.² Epidemiological studies suggest an increased prevalence of wounds in high-income countries such as the US,³ Australia⁴ and Germany.⁵ Moreover, this prevalence is even higher in lower- and middle-income countries because of poor medical infrastructure.⁶

Best practice evidence suggests that the management of wounds should be done with an ‘ideal’ dressing agent that simultaneously simulates an environment which facilitates the growth of granular tissue while inhibiting the growth of infectious microorganisms.⁷ The literature suggests several potential antimicrobial agents, including silver, gentian violet and polyhexamethylene biguanide to achieve these effects.⁸ Among them, the role of povidone iodine dressing has been studied the most.⁷ In a study by Bigliardi et al.⁹ the strong bactericidal properties of povidone iodine were demonstrated. The authors reported that povidone iodine can effectively inhibit vital cellular and structural pathways in the bacterial cellular membrane, including the oxidation of amino acids and nucleotides.¹⁰ Several in vitro studies have also confirmed these claims and have reported strong potency of povidone iodine against Gram-positive (Staphylococcus aureus)¹¹ and Gram-negative bacteria (Serratia marcescens),¹² and a range of protozoa,¹³ fungi¹⁴ and viruses.¹⁵ Reviews of in vivo studies in humans have also reported compelling evidence in favour of povidone iodine-based wound dressings.^9,¹⁶

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antimicrobial

antisepsis

dressing

honey

infection

povidone iodine

ulcer

wounds

wound-healing

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