Best evidence topicMedical grade honey in the management of chronic venous leg ulcers

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was: In patients with chronic venous leg ulcers (CVLU), does the use of medical grade honey as compared to standard wound therapy improve clinical outcomes?A total of 299 papers were identified using the search protocol described, of which five represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.Two randomised controlled trials arrived at contradictory conclusions: one showing better outcomes for CVLU healing with use of honey over standard wound therapy and the other showing equivalent outcomes but more adverse effects. A third randomised controlled trial showed a non-significant reduction in bacterial colonisation of CVLU with honey compared to standard therapy. Two further studies - a prospective cohort study and a case series - supported the use of honey, but these were of lower grade evidence and had numerous methodological faults.Therefore, the clinical bottom line is that there is no conclusive evidence that honey improves outcome in patients with CVLU, and until more robust trials are conducted, its benefit should be considered unproven.