This article is a collaboration between MedPage Today® and:
A clinical trial of medical grade honey to prevent infection in peritoneal dialysis patients did not have a sweet outcome -- the sticky substance didn't work.
Indeed, in a subgroup of patients, prophylactic honey was associated with an increased risk of infection at the site of the dialysis catheter, according to David Johnson, PhD, of the Princess Alexandra Hospital in Brisbane, Australia, and colleagues.
The finding, from a randomized open-label trial, compared topical anti-bacterial honey with standard exit-site care or (in carriers of nasal Staphylococcus aureus) intranasal mupirocin (Bactroban) prophylaxis, Johnson and colleagues reported online in The Lancet Infectious Diseases.
It's the first time honey has been tested as an anti-bacterial agent in peritoneal dialysis, the researchers noted, although there is evidence that honey is "an inexpensive, safe, and effective anti-microbial agent."
It has the advantage, they noted, that it doesn't lead to antibiotic resistance.
While that makes honey "an attractive option for preventing infection at wound sites," Johnson said in a statement, "our results suggest that honey cannot be routinely recommended for the prevention of infections related to peritoneal dialysis."
The researchers enrolled 317 people undergoing peritoneal dialysis and randomly assigned them in a one-to-one fashion to daily topical honey or to standard care plus mupirocin where warranted.
The primary endpoint was the time to the first infection related to dialysis -- an exit-site infection, tunnel infection, or peritonitis.
The investigators found there was little difference between the arms: the median time to first infection was 16 months in the honey group and 17.7 months in the control group.
Those times led to an unadjusted hazard ratio for infection of 1.12, with a 95% confidence interval from 0.83 to 1.51, which was nonsignificant at P=0.47.
On the other hand, Johnson and colleagues found, patients with diabetes appeared to do worse with the honey. They had an increased risk of both the primary endpoint and peritonitis, with significant hazard ratios of 1.85 and 2.25, respectively.
But the investigators cautioned that that finding arose from a subgroup analysis and needs further investigation, even though the subgroup was prespecified.
The disappointing result might not be entirely due to a lack of an anti-microbial effect of honey, according to Achim Jorres, MD, of Berlin's Charite Clinic and Wim van Biesen, MD, PhD, of the Ghent University Hospital in Belgium.
In an accompanying commentary, they argued that the daily manipulation needed to apply the honey might have caused "microtrauma" that counteracted the benefits of the honey.
"The important question of whether patients with a healthy catheter exit site for peritoneal dialysis should receive prophylactic treatment remains to be addressed," they wrote.
"In our view," they argued, "the key to preservation of exit-site integrity is optimal catheter fixation and avoidance of unnecessary manipulations."
The study had support from Baxter Healthcare, the Queensland Government, Comvita, and Gambro.
Johnson reported financial links with Baxter Healthcare, Fresenius Medical Care, and Gambro.
- Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
The Lancet Infectious DiseasesSource Reference: Johnson DW, et al "Antibacterial honey for the prevention of peritoneal dialysis-related infections (HONEYPOT): A randomised trial" Lancet Inf Dis 2013; DOI: 10.1016/S1473-3099(13)70258-5.
The Lancet Infectious DiseasesSource Reference: Van Biesen W, Jörres A "Medihoney: let nature do the work?" Lancet Inf Dis 2013; DOI: 10.1016/S1473-3099(13)70284-6.