Niels A. J. Cremers

Background: Burn wounds in companion animals are uncommon but can lead to serious complications and be lifethreatening, requiring prompt and effective wound care. Conventional treatment methods often involve silver- or antibiotic-based products, which carry disadvantages such as cytotoxicity and risk of antimicrobial resistance. Medicalgrade honey (MGH), especially when supplemented with vitamins C and E, offers a potential alternative due to its antimicrobial, anti-inflammatory, and wound-healing properties. Aim: This study aims to evaluate the clinical outcomes of vitamin-supplemented MGH in the management of burn wounds in cats and dogs. Methods: A retrospective, multi-center case series was conducted across three veterinary clinics in Romania, Greece, and the Netherlands. Nine cases involving cats (n = 4) and dogs (n = 5) with thermal, chemical, or iatrogenic burn wounds were included. All wounds were treated with MGH-based products (L-Mesitran range), and wound progression was documented photographically. Descriptive statistics (mean ± SD) were calculated for key parameters, including time to visible inflammation reduction, debridement, granulation tissue formation, re-epithelialization, and complete healing. Results: All patients achieved complete wound healing without complications. On average, signs of inflammation reduced within 5.2 ± 2.0 days (mean ± SD), debridement occurred in 6.7 ± 2.2 days, granulation tissue appeared after 11.7 ± 4.1 days, re-epithelialization was shown in 23.6 ± 5.9 days, and full wound closure was achieved in 64.7 ± 20.7 days. These clinical outcomes varied between individual cases, depending on wound age, size, severity, location, and patient characteristics. Conclusion: Vitamin-supplemented MGH showed promising outcomes in promoting wound healing in feline and canine burn patients. However, the small sample size, retrospective design, and lack of a control group limit the generalizability of these findings.

Hard‐to‐heal wounds are frequently associated with underlying conditions such as diabetes, vascular disease, and biofilm‐related infections. Accurate identification of microbial origin is essential, but is often hindered by biofilms. This study evaluated whether sonication of wound dressings, combined with different sample transport methods, improves bacterial detection in venous leg ulcers. In a prospective observational case–control study, six patients with hard‐to‐heal venous leg ulcers received treatments with medical‐grade honey (MGH) ( n = 1), ceramic dressings – “Cerdak” ( n = 2), or hydroactive dressings ( n = 3). Three microbiological samples were collected per patient: (1) conventional wound swab (Levin's technique) in Amies medium; (2) sonicate fluid from used dressings transported in sterile tubes without medium; and (3) sonicate fluid in haemoculture tubes (BACT/ALERT). Total pathogen count and diversity were compared across sampling methods. Patient quality of life (QoL) was assessed using the Wound‐QoL instrument. Sonication revealed additional pathogens not detected by conventional swabs. The highest number of pathogens was found in sonicate fluid transported in haemoculture tubes ( n = 43), followed by swabs ( n = 39) and sterile tube transport ( n = 30). Adequate treatment significantly improved patients' QoL during the healing process. Dressing sonication, especially with haemoculture tube transport, enhances microbial identification and may improve diagnosis and management of hard‐to‐heal wounds.

Background: Aggregatibacter actinomycetemcomitans JP2 genotype is a virulent pathogen linked to severe periodontitis and systemic diseases. Honey and royal jelly (RJ) have demonstrated bioactive properties against this microorganism. This study aims to assess the bioactive properties of honeys and RJ against this key periodontal pathogen and to preliminarily identify key compounds with antibacterial potential. Methods: The antibacterial activity of honeys and commercial products (manuka, L-Mesitran^® as a medical-grade honey-based formulation (MGHF), and Honix^® RJ) against A. actinomycetemcomitans JP2 was evaluated using the agar well diffusion method and microdilution assays. Extensive physicochemical characterization (e.g., hydrogen peroxide level, total phenolic content, and total flavonoid content) was conducted to correlate the bioactive compounds with the antimicrobial activity. Results: All tested samples exhibited varying antibacterial potency, with inhibition zones ranging from 21 to 37 mm. The MICs ranged from 40.7 to 104.3 mg/mL. MGHF, RJ, and multifloral honeys showed the lowest MICs. The pH of six out of eight samples could not induce enamel decalcification while the pH of three samples may not influence cementum demineralization. Vitamin C, zinc, magnesium, and potassium were present in measurable quantities, and were not associated with significant antibacterial activity. MGHF showed the highest hydrogen peroxide activity and TFC values. TFC and H₂O₂ content were statistically correlated with lower MIC values. Conclusions: Honey and RJ showed antibacterial activity against A. actinomycetemcomitans JP2, partly attributed to their content of hydrogen peroxide and flavonoids. Clinical trials are needed to confirm the potential role of honey, RJ, and their bioactive compounds in managing periodontitis.

Introduction High-grade squamous intraepithelial lesions are caused by persistent high-risk human papillomavirus (hr-HPV) infections and are subdivided into cervical intraepithelial neoplasia (CIN) lesions: CIN II (moderate) and CIN III (severe). Current treatment options for CIN II include large loop excision of the transformation zone, imiquimod and expectant management. Each treatment option has its drawbacks, and therefore, a non-invasive treatment is desirable. Preliminary evidence shows that medical-grade honey (MGH) has antiviral activity and might be able to modulate the vaginal microbiome, reduce local inflammation or directly influence the intralesional immune response within cervical tissues. Therefore, this study aims to investigate the possible effect of MGH on hr-HPV clearance and to investigate the possible underlying mechanisms contributing to the regression of CIN II lesions. Methods and analysis This study is performed in the Zuyderland Medical Centre and Maastricht University Medical Centre+. A total of 60 eligible women with newly histologically confirmed CIN II will receive MGH (L-Mesitran Soft) for intravaginal use for 6 months. The primary objective is to investigate the effect of MGH on the hr-HPV clearance after 6 months. Secondary aims are the effect of MGH on the regression of CIN II lesions, clearance of hr-HPV at 12 and 24 months and the role of the vaginal microbiome, local immune system and intravaginal inflammatory status in response to MGH. Moreover, data on quality of life, side effects and compliance will be collected. Ethics and dissemination Ethical approval from the Medical Ethics Review Committee of the Zuyderland Medical Centre Heerlen has been obtained (NL86044.096.24 on 24 April 2024). The results will be presented to researchers and healthcare professionals through conferences, meetings and publications in international journals. Trial registration number NCT06219018.

The surge in the use of honey in modern medicine, driven by concerns over escalating antibiotic resistance, places an unprecedented emphasis on the need for medically safe and effective honey. In response, the term ‘medical-grade honey’ (MGH) emerged, accompanied by stringent criteria. However, the evolving landscape of honey authenticity challenges and new medical device regulations demand a comprehensive revision of MGH criteria and a refined definition. This article provides a clear definition of MGH and refines its standards. MGH must be: organically produced; undergo gamma sterilisation; adhere to clinical safety benchmarks; meet production standards; and meet specific physicochemical criteria, affirming its suitability for medical use. Furthermore, the authors advocate for proven biological activity in MGH, including antimicrobial and antioxidant properties, vital for medical efficacy. This paper also sheds light on significant regulatory shifts introduced by the European Union's Medical Device Regulation, enhancing device safety while demanding increased investment in terms of cost and effort. In summary, the presented refined guidelines ensure secure, effective honey use in medical contexts, reaffirming MGH's role in modern healthcare.

Background/Objectives: Foam dressings are designed for their ability to manage exudate and are selected to optimize wound repair. Various foam dressings are available, ranging from basic polyurethane to more sophisticated options, incorporating active components to combat infections or foster healing. This study investigates the requirements for the most suitable foam dressing through a combination of field research, laboratory testing, and clinical evaluation. Methods: We tested 17 foam dressings commonly used by wound care professionals while attending an international conference. An effective foam dressing should absorb wound fluid for several days, as wound care professionals value absorption and retention capacity, often favoring less frequent changing dressings, preferably twice a week or even weekly. Results: The foam dressings tested can absorb the expected amount of exudate typically produced by different wound types. There is some variability in retention capacity and product prices, resulting in differences in cost-effectiveness among products. In addition, some dressings are enriched with active ingredients that can accelerate healing through their antimicrobial and anti-inflammatory properties, such as foam dressings infused with silver or honey. A honey-based foam dressing was evaluated in a clinical survey involving eight wound care specialists, and four clinical cases with varying wound pathologies were discussed in more detail to highlight its key properties. Conclusions: Ideally, a foam dressing should have adequate absorption and retention capacities, effectively resolve and prevent infections, protect against external trauma, ensure optimal patient comfort without damaging newly formed granulation tissue, accelerate wound healing processes, and reduce wound care time (e.g., remaining in place for 7 days). Together, these factors make honey- or silver-loaded foam dressings more cost-effective than plain dressings due to their antimicrobial activities and ability to nourish tissues.

Background/Objectives: During vaginal delivery, the perineum can be damaged either by episiotomy or by a spontaneous perineal tear, leading to several complications. The wound healing process should proceed as quickly and properly as possible without an infection. Medical grade honey (MGH) may be a potent treatment option due to its antimicrobial and pro-healing activities. This literature study investigated the role of honey in the treatment of vaginal wounds after delivery. Methods: Studies published before 17 July 2024 in the PubMed, Web of Science, Embase, Scopus, EBSCO host/CINAHL, Cochrane Library, and Google Scholar databases about honey, episiotomy wounds, and perineal tears, as well as those investigating wound healing and/or pain, were assessed. Results: Ten studies were included (six RCTs, of which three were double-blind, one was quasi-experimental with a posttest only, and three were observational studies without a control group), with 723 participants in total. Six of the seven controlled studies showed honey significantly improved various outcome measures, such as improved wound healing, and reduced need for pain medication. The three non-controlled studies also had a positive outcome, improving wound healing and decreasing pain intensity and prickling sensation. However, the overall quality of available evidence is limited. Different types of honey concentrations, origins, and additives were used in the included studies. Using a standardized MGH formulation may help to maintain consistent and potent effects. Therefore, additional research is needed to determine the efficacy of MGH in perineal trauma and to establish guidelines for clinical use. Conclusions: Honey potentially has a great effect on wound healing of perineal trauma; however, more research is necessary to substantiate the findings in the current literature.

The integration of apitherapy into modern medicine requires robust documentation and communication of its clinical efficacy. This paper addresses the need for standardized protocols to guide case studies in apitherapy, ensuring credibility and comparability across treatments. By outlining essential parameters for case documentation—including patient history, experimental conditions, product characterization, and evaluation criteria—this framework aims to enhance the quality and acceptance of alternative treatments. The proposed methodology aligns with established guidelines from organizations like the Joanna Briggs Institute and Cochrane, facilitating the adoption of a common language in integrative medicine. Standardized protocols will support practitioners in demonstrating the efficacy of apitherapy while adhering to ethical and regulatory standards. Ultimately, these measures aim to bridge the gap between anecdotal evidence and scientific validation, fostering greater trust and integration of apitherapy within conventional medical practice.

Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. Innovative and improved therapies are thus required to resolve local infection and enhance the wound healing process. The objective of this study was to evaluate the effectiveness of medical-grade honey (MGH) for the treatment of clinically infected and non-healing VLUs. This prospective case series included nine patients with an average age of 83.4 years (range: 75–91 years) with a total of eleven VLUs, previously ineffectively treated with various products. Major risk factors for the appearance of VLUs were chronic venous insufficiency, advanced age, multiple comorbidities (particularly cardiovascular diseases), and impaired mobility. All wounds presented with local signs of infection. Upon presentation, treatment was commenced with a range of MGH-based products (L-Mesitran^®). Clinical signs of infection were eliminated by MGH after 2.2 weeks on average (range: 1–4 weeks), and wounds were completely healed after 7 weeks on average (range: 3–18 weeks). No further complications or recurrences were observed. MGH has a broad-spectrum antimicrobial activity and promotes rapid healing, thus improving patients’ quality of life. Moreover, MGH-based products are safe, easy to use, cost-effective, and can effectively treat VLUs alone or in combination with standard-of-care therapies.

The prevalence of bacterial vaginosis (BV) among women of reproductive age is 29%. BV arises from a vaginal imbalance marked by reduced levels of lactic acid-producing lactobacilli and an overgrowth of pathogenic anaerobes. The multifactorial nature of BV’s pathogenesis complicates its treatment. Current antibiotic therapy exhibits a recurrence rate of about 60% within a year. Recurrence can be caused by antibiotic treatment failure (e.g., due to antimicrobial resistance), the persistence of residual infections (e.g., due to biofilm formation), and re-infection. Because of the high recurrence rates, alternative therapies are required. Medical-grade honey (MGH), known for its antimicrobial and wound healing properties in wound care, emerges as a potential novel therapy for BV. MGH exerts broad-spectrum antimicrobial activity, employing multiple mechanisms to eliminate the risk of resistance. For example, the low pH of MGH and the production of hydrogen peroxide benefit the microbiota and helps restore the natural vaginal balance. This is supported by in vitro studies demonstrating that MGH has an antibacterial effect on several pathogenic bacteria involved in the pathophysiology of BV, while lactobacilli and the vaginal microenvironment can be positively affected. In contrast to antibiotics, MGH exerts anti-biofilm activity, affects the microbiome as pre- and probiotic, and modulates the vaginal microenvironment through its anti-inflammatory, anti-oxidative, physicochemical, and immunomodulatory properties. More clinical research is required to confirm the positive effect of MGH on BV and to investigate the long-term cure rate.