Forty-three studies (n = 2,316) were included in the review, of which 20 were described as RCTs. The mean Jadad score was 0.86. The median was 0 as a result of applying the Jadad scale to non-RCTs. Only four studies scored 3 or more points.
Wound healing (19 studies). Two RCTs compared honey dressings with paraffin gauze (1 RCT) or iodine (1 RCT) dressings. In both studies the comparator was found to be significantly more effective than honey. Seventeen low-quality studies were considered to collectively show benefits for honey in situations including post-operative wound infections, leg ulcers and Fournier's gangrene across a range of outcomes including infection rates, need for antibiotics, extent of scarring and reduction in pain.
Burns (11 studies). Eight low-quality studies found that honey produced better results in terms of wound healing time and infection rates compared with other topical treatments. Three RCTs produced mixed results. One found honey to be more effective than paraffin gauze. Of the two that compared honey with silver sulphadiazine, one found honey to be more effective and one found no difference between the groups.
Skin conditions (three studies). All three non-comparative studies found honey to be useful in managing conditions including seborrheic dermatitis, dandruff, psoriasis and fungal conditions.
Cancer patients (five studies). One small good-quality RCT showed that honey reduced the severity and duration of radiation-induced mucositis and prevented weight loss. The remaining studies showed results suggesting that honey was associated with less tooth decay in head and neck cancer patients with xerostomia (two studies) and that honey promoted wound healing in cancer patients (one paediatric population, one post-vulvectomy).
Miscellaneous uses (five studies). One small high quality RCT found no difference between honey and placebo in the treatment of rhinoconjunctivitis. Other studies assessed patients undergoing haemodialysis, treatment of central vein catheter exit sites, bleeding gums and gastroenteritis.