# Honey-Based Medicinal Formulations: A Critical Review
## 3 Honey-Based Medicinal Formulations
### Honey-Based Dressings  
A variety of honey-based dressings are available in the market as over-the-counter (OTC) and prescription medicines. These dressings are indicated for different types of wounds, such as abrasions, lacerations, burns, traumatic and surgical wounds, diabetic foot ulcers, and leg ulcers. As can be seen from the information presented in Table 2, the evidence of the effectiveness of honey-based dressings can be derived from different in vitro and in vivo studies [31; 32], as well as from clinical studies [33; 34; 35; 36]. The honey used in these dressings is mainly New Zealand medical-grade _Leptospermum_ Manuka honey, which may be mixed with other agents, such as polymers, purified water, lanolin, and various other natural agents. Buckwheat honey is another honey that has been formulated into medicinal dressings. Dermagnetics manufactures MelMaxTM wound dressing using buckwheat honey mixed with a polyhydrated ionogen ointment. DermaSciences manufactures honey-based dressings under the brand name 'MedihoneyTM', which comprise 95% active Manuka honey and 5% calcium alginate. The alginate forms a gel by absorbing wound exudate, which helps to maintain a moist wound environment that aids the autolytic debridement [37]. Under the supervision of a healthcare professional, these MedihoneyTM dressings may be prescribed to manage moderately to severely exuding wounds. Another product is the Medihoney Adhesive/Non-adhesive Honey Hydrocolloid SheetsTM, which consist of 80% active Manuka honey and 20% sodium alginate, indicated for lightly to moderately exuding wounds. Similarly, hydrogel colloidal sheets with 63% _Leptospermum_ honey with and without an adhesive border are directed for the management of non-draining to lightly exuding wounds. A study carried out by [PERSON] et al. showed that MedihoneyTM may have a significant role to play in infection prophylaxis, as its findings confirmed that MedihoneyTM is as effective as muiprocin in the prevention of catheter-associated infections [38]. A randomized controlled trial conducted by [PERSON] et al. using topical MedihoneyTM and a dressing (or dressing system) selected from Aintree University Hospitals NHS, Liverpool, UK in accordance with standard local practice found a 10% acceleration in the healing rate of honey-treated wounds compared to conventionally treated wounds [22]. Moreover, [PERSON] et al. undertook a prospective observational study using MedihoneyTM focused explicitly on chronic pressure ulcers. They found that the honey-based formulation destroyed bacterial growth in all 20 ulcers treated, with 90% of patients showing complete wound healing after 4 weeks [39]. There are several other types of honey-based dressings available commercially. The New Zealand-based Manuka Health (Newmarket, Auckland) manufactures a glycerin-based honey-containing hydrogel sheet for wound covering, and another New Zealand-based company, ManukaMed Ltd. (Solway, Masterton), offers gauze-based, honey-impregnated fiber pad wound coverings. United Kingdom-based Advancis Medical (Kirkby-in-Ashfield, Nottinghamshire) produces numerous types of Manuka honeycomb-impregnated coverings containing cellulose-based net dressings (Actilite(tm) and Activone Tulle(tm)) and alginate hydrogels (Algivon(tm), Algivon Plus(tm)). Links Medical Products Inc. manufactures dressings like Manuka foam HC(tm), Manuka Fill(tm), Manuka IG(tm), and Manuka IG Max(tm), which are all composed of _Leptospermum scoparium_ honey from New Zealand. The single-use Manuka foam HC(tm) consists of honey infused into an absorbent foam-fiber hybrid material, with a polyurethane border and either a silicone or acrylic adhesive. Manuka Fill(tm) is a sterile, single-use wound care dressing consisting of 100% _Leptospermum scoparium_ honey from New Zealand wrapped in low-density polyethylene (LDPE) tubes following sterilization by gamma irradiation. Manuka IG(tm), a sterile, single-use wound dressing, is formulated with honey infused into acetate gauze and coated with carboxymethyl cellulose (CMC).