When will we take medicinal honey seriously?

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Honey is now regularly being shown to kill superbugs in the laboratory and save patient's limbs on hospital wards, but why is its medicinal use still so limited in the UK?

The antibacterial properties of honey have long been known, both ancient Greek and Egyptian physicians are said to have valued it and it was used in the treatment of wounds right up to World War Two.

Honey's reputation was relegated to that of an old wives' tale in the twentieth century after the discovery of penicillin heralded the widespread use of antibiotic drugs to combat infections.

But with antibiotic resistance now high on the global agenda, scientists and doctors are working together to once more prove honey's effectiveness in battling life-threatening bacteria.

Researchers say honey has been successful in treating severe wounds including ulcers, pressure sores, trauma injuries and infected surgical wounds - reducing the reliance on antibiotics and providing an alternative to antiseptics which can harm healing tissue.

Ischaemic leg Engineered honey successfully treated a patient who was facing amputation due to large ischaemic ulcers which had become infected with pseudomonas bacteria.

Filtered or medical-grade honey is used in licensed wound-care products around the world. However large-scale randomised clinical trials have yet to take place in this country so its use remains low compared with other wound treatments like silver and iodine.

Those looking into its curative potential claim this may be due to it being a natural product which attracts scepticism from medical scientists. Organisations which fund medical research say no such stigma exists, grant applications simply need to be robust.

Sam Edwards, a maintenance engineer from Wrexham, Wales, is a recent convert to the power of honey, after developing a rare skin condition caused by a cut from a koi carp infected with Mycobacterium marinum.

"The pain is like having a bath in a deep fat fryer 24 hours a day," Sam said. "It put me in a wheelchair for a long time as well as meaning long stays in hospital and mechanical dermabrasion."

Antibiotics caused jaundice and doctors began to talk about multiple amputations so Sam looked around for alternative treatments and tried everything from steroids to maggots but nothing worked.

In December 2012 Sam was introduced to manuka honey dressings by a street doctor from Venezuela. By January 2014 Sam had found a UK supplier and began the treatment.

Manuka Prof Cooper's long-standing research has focussed on honey from the New Zealand manuka plant

"It has turned my life around. It hurts a little bit the first time you use it but in the space of five months I am almost completely healed, it's amazing," Sam said.

Manuka honey comes from the New Zealand manuka plant and has been available on prescription in the UK for the last 10 years.

Professor Rose Cooper, from the Centre for Biomedical Sciences at Cardiff Metropolitan University, has been at the forefront of its research since the late 1990s.

Using electron microscopy, which can reveal the structure of bacteria, she has shown even low concentrations of the honey stops bacteria including MRSA growing, meaning cells cannot divide and therefore are unable to form infections.

Combining honey with oxacillin and other antibiotics has also been shown to be more effective against antibiotic resistant bacteria.

She is currently investigating how different bacteria seem to be affected in different ways by manuka honey, believing it to have a wider application than just killing bugs.

Prof Cooper said she has often found it difficult to get her research published but admits the scientific standards of clinical work with honey has been varied.

"One of the problems is a good clinical trial should be a double blind so that neither the patient nor the practitioner will know which of the patients are having the intervention that's being tested," she said.

"The trouble with honey is the patients know its sticky, they can smell it, and of course the practitioners know too, so it's very difficult to achieve that best quality."

In a clinical setting, research has so far been small-scale, but dramatic results have been reported.

Dr Matthew Dryden, consultant in infection and microbiology at Hampshire Hospitals NHS Foundation Trust, has seen a number of patients' wounds transformed by honey.

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He uses an engineered version, called Surgihoney, as a wound dressing after carrying out laboratory tests against bacteria gathered from infected wounds.

Surgihoney killed all of the bugs including multiple drug-resistant ones like MRSA, Ecoli and pseudomonas aeruginos and its effects were comparable to commonly-used antiseptics, which can have adverse side effects.

"There was one man with an ischaemic leg, where it was really a choice between amputating the leg and/or giving him potent systemic antibiotics," Dr Dryden told BBC Nature.

"The ulcer was heavily colonised with Pseudomonas aeruginosa, which is a nasty, often resistant bug so we put daily (Surgihoney) dressings on the ulcer.

"By day eight the bacteria had completely disappeared and the ulcer had started to get better, so for the time being it had saved his leg, it prevented him from having antibiotics and got him out of hospital."

Dr Dryden has also shown that the product can reduce infection rates following caesarean sections and also those associated with cancer patients receiving chemotherapy treatment through intravenous lines.

Like Prof Cooper, Dr Dryden also believes honey products have more potential uses and would like to carry out full randomised trials.

But an application for funding to carry out such research was rejected by the National Institute for Health Research (NIHR).

"Despite all the publicity about antibiotic resistance, using a so-called natural product is not terribly sexy, scientifically," Dr Dryden said. "There's a lot of snake oil salesmen out there who claim all sorts of things for all sorts of natural products.

Hives in Chile The idea for Surgihoney came from Ian Staples' bee hives in Chile

"But we've actually got more patient data than many wound dressing treatments. I think because its honey it seems a bit alternative and that puts the scientists off."

High quality trials could also be carried out by big wound care companies. The father and son team behind Surgihoney are talking to several firms about developing it commercially.

The idea began on a farm in Chile owned by former managing director Ian Staples. Having decided to keep bees on the farm he spotted that the honey they produced did not spoil in the hive, suggesting natural antimicrobial activity.

In fact, an enzyme inside honey produces hydrogen peroxide which is a well-known disinfectant.

Ian and his son, Stuart, who now live in West Sussex, commissioned scientists to develop a product which boosted the antibacterial properties of any organic honey.

"When we first started this the doctors we worked with said this was as big a breakthrough as penicillin," Stuart Staples said. "Whether it is or not that's why we bet the farm on it."

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He estimates that health organisations in the UK currently spend less than £3 million ($5.1 million USD) a year on honey dressings, compared with £60 million ($101.8 million USD) spent annually by the NHS on antiseptic silver products.

"Dr Margaret Chan from the World Health Organisation said in the future a scratched knee could kill you and we're saying 'no it couldn't' because we have a device that no bug can survive contact with," Mr Staples said.

Organisations which fund medical research in the UK say all grant applications are subject to peer review and judged in open competition.

A Department of Health spokesperson said: "Britain's reputation as a world leader in science, research and development depends upon innovative approaches to improving treatments and finding new cures.

"The NIHR welcomes funding applications for research into any aspect of human health, including in this case, the use of honey as an antimicrobial agent."

The Wellcome Trust said it has not funded any research into honey but said this could be for a variety of reasons including no bids being made, bids not being relevant to the funding criteria or the science not being of high enough quality.

The Medical Research Council (MRC) said it had also not funded any studies with honey but that did not mean it would not do so in the future.

It added that it is currently inviting bids for funding as part of a new collaboration between all seven UK research councils to tackle antimicrobial resistance.

Hive Alive concludes on BBC Two, Tuesday 22 July 2014 at 20:00 BST.

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