Medicinal honey shows impressive results in combatting antibiotic resistance, improving patient welfare and economizing wound management for humans and companion animals.

When the source of honey is well chosen, there are no mentionable side effects or contra-indications.

Honey is roughly 80 per cent simple sugars (such as glucose and fructose) and 20 per cent water and also contains more than 200 different bioactive compounds (including proteins, enzymes, amino acids, phytochemicals, vitamins, antioxidants and minerals).

Its therapeutic potency is complex. It contains compounds both known and unknown by the scientific world. It is a product of nature and thus variations in composition occur between geographical locations of the hive, season, weather and the bee’s pasture conditions. As a result of this variability, science struggles to fully standardize, quantify and qualify the healing benefits of honey.

The healing property that has received the most intense investigation is its antimicrobial properties, which are both bacteriostatic and bactericidal. They are potent enough to penetrate the stubborn bio-films often found in chronically poor-healing wounds.

Not as easy to quantity and qualify are the properties associated with its abilities to modify the wound environment and greatly favour the healing outcome.

When bees are digesting nectar to produce honey, they remove most of the water content and what remains is tightly bound to the sugars. The peculiar sugar-water combination acts as a poultice and contains a tremendous bank of bioactive components.

These components are responsible for up-regulating the production of proteins and enzymes that support debridement of dead, septic and damaged tissue; decrease inflammation; and nourish the formation of new cellular components, blood vessels and collagen organization.

As a result, wounds treated with honey tend to have minimal scar formation and in animal patients hair growth is often restored. The precise mechanisms, however, are not completely understood.

Researchers have paid the most attention to Manuka honey from honeybees that feed on the nectar of manuka flowers in New Zealand. Multiple pathways of anti-microbial action have been discovered in Manuka honey and this unique factor has been standardized and has a certification, UMF, which stands for Unique Manuka Factor. (The label the level of methylglyoxal, the compound in the honey with antibacterial properties.) Manuka honey is the only type graded for antibacterial activity and the UMF scale runs from zero to 30. Medically graded honey will have this on its packaging.

As the UMF grade rises, so does the price. Various studies have shown that a rating of 10 or more is sufficient to provide antimicrobial activity in the wound environment. Although it was originally thought that Manuka was the most potent antimicrobial honey, a number of others are comparable.

The remedial activity of honey upon the wound will depend upon its source. It is advisable to use a medical-grade honey or a well-chosen raw honey from a reputable local apiary.

Use caution with generic store-bought honey because many commodity types, especially some imports, undergo various forms of processing, adulteration, dilution with syrups, heat treatments, pasteurization and unfavourable storage conditions. These sources of honey can be harmful to wound healing under some circumstances.

Honey can be applied directly to the wounded area or delivered in medical formulations of gels, pastes, salves, flushes or via honey-impregnated wound dressings.

Application of honey to the wound is painless. A reasonable prescription for a honey cover is about 30 millilitres of honey (two tablespoons) for dressing a wound 10 centimetres by 10 centimetres, (roughly the size of an adult handprint).

Deep wounds or abscesses can be filled with honey. It is important that the wounded area be in contact with honey at all times, especially if exposed bone is present. Bandaging may be required to meet this criteria.

Honey application can be messy, with everything in the barnyard sticking to it, including flies. Surprisingly this does little to affect results. Honey tends to soldier on despite a surface layer of barnyard fodder. This sticky inconvenience can be mitigated with a bandage cover.

Honey bandages are easily and painlessly removed. Any remaining debris is easily rinsed away and redressing can take place with minimal tissue trauma and/or bleeding.

Honey can be used long-term as there are no negative effects on the tissues. A pleasant effect of a dressing wounds with honey is its deodorizing ability. Expired honey bandages and/or dressings do not have an offensive odour despite the foul appearance of the bandage.

The majority of traumatic wounds in horses are managed by secondary intent, for example open wounds. Wounds of the distal limb in horses are particularly difficult to manage due to constant exposure to contamination, movement and minimal soft tissue cover.

Honey treatment has proven helpful at reducing the complications of proud flesh and/or exuberant granulation tissue, exposed bone and may even be beneficial in preventing infection and dehiscence of lacerations that have been surgically closed.

Honey can modify the wound environment and significantly advance healing through a synergy of helpful actions and a bank of antimicrobial agents.

As a result of improved outcomes, financial implications and animal welfare, honey therapy is gaining popularity.