A trial published in The Lancet Infectious Diseases shows that applying medical grade honey to wounds of patients undergoing dialysis does not have an advantage over normal antibiotic use.
Researchers say this finding will come as a disappointment to clinicians, some of whom hoped honey would offer a better substitute for antibiotics.
Peritoneal dialysis is a procedure used to clean the blood of patients who have kidney failure. It is carried out by inserting a catheter into the peritoneum - a thin membrane surrounding organs in the abdomen.
This procedure is used in over 200,000 patients with kidney failure each year around the world, researchers say. However, it carries with it risks of infection at either the site of the catheter insertion or in the peritoneum, which is called peritonitis.
Sometimes a life-threatening infection, peritonitis is usually treated with antibiotics, but the researchers say only a narrow range of infections are covered by the types of antibiotics that doctors are able to use in such situations.
And overuse of antibiotics is contributing to antibiotic resistance. Medical News Today recently reported that bacteria speak a "universal language" to build up antibiotic resistance.
Honey hopes dashed
The researchers say that antibacterial honey has previously shown promise as a new, cheap and effective "prophylactic agent" that does not promote resistance from microbes.
Medical grade honey is made by sterilizing standard honey.
As a result of the encouraging findings around the bee-made compound, researchers in Australia set out to test how honey performed when applied each day to the wound sites of patients receiving peritoneal dialysis.
The team compared this with a standard antibiotic treatment that is applied nasally, called mupirocin.
In the trial, 371 patients were recruited from 26 medical centers in both Australia and New Zealand. Of these patients, 186 received a daily application to the site of the catheter insertion of 10 mg of medical grade honey.
The control group consisted of 185 patients who were tested for nasal carriage of Staphylococcus aureus and treated with the mupirocin if they tested positive. If they tested negative, they received standard wound care.
There was no significant difference in the average time to first infection between the honey and control groups. Patients in the honey group had an average of 16 months until their first infection, while the control group showed an average of 17.7 months.
Additionally, the first time to infection in patients with diabetes was much sooner in the honey group, at 11.6 months on average. Plus, the risk of peritonitis was nearly twice as high, compared with diabetic patients in the control group.
Avoiding infection in the first place 'is key'
As a result of the findings, the researchers say that they cannot recommend honey for the prevention of infections related to peritoneal dialysis.
Professor David Johnson, of the Australasian Kidney Trials Network, says that they had a high rate of patient withdrawal from the honey group, at either the request of the patient or physician.
"This suggests that patients may have found the daily application of honey to the wound site uncomfortable or inconvenient," he says.
In a comment paper on the study, Professors Achim Jörres and Wim van Biesen note that the discouraging effectiveness of honey may not be completely due to the honey's properties as an antibacterial agent:
"Although the results of [this study] show the efficacy of mupirocin versus Medihoney, the important question of whether patients with a healthy catheter exit site for peritioneal dialysis should receive prophylactic treatment remains to be addressed."
"In our view, and according to the principle of primum non nocere (first do no harm), the key to preservation of exit-site integrity is optimal catheter fixation and avoidance of unnecessary manipulations."