Surgihoney - Modified honey wound treatment: first report of in vitro
activity and early clinical evaluation
Dryden MS1, Hudgell2, Saeed K1, Dryden AWS 3 , Brooks J4,Cooke J2
1 The Hampshire Hospitals, SO22 5DG, 2 Imperial College London, 3 Vav’u hospital Tonga and
Peninsular Medical School UK, 4University of Hull.
METHODS AND RESULTS
THE HONEY
Methods:
Surgihoney and comparators were tested by a
diffusion inhibition method and MIC/MBC
measurement against a range of human pathogens
cultured from wounds, including Staph. aureus, Esch.
coli, Pseudomonas. aeruginosa, Streptococcus Group
B. Strains included MRSA ( hospital, and community
acquired producing PVL) and ESBL-producing Esch.
coli.
Background:
The past century has seen increased use of chemical antiseptics
and antibiotics in wound infection treatment. Whilst these may
control microbial overgrowth, they may be toxic to tissue healing,
and there has been a worrying growth in microbial resistance.
•  Surgihoney is a CE approved medical device. It is a
mainstream managed medical product.
•  Surgihoney is a controlled and managed product where it’s
key point of difference from all medical grade honeys is the
broad spectrum antimicrobial characteristics.
Patients with skin lesions ranging from severe varicose
ulcers, pressure sores and infected traumatic wounds
have been treated topically with Surgihoney as part of
a non-comparative clinical evaluation.
•  It is scaleable. It does not depend on one floral source. It
has the ability to be a global wound infection control and
therapeutic product - hence the pilot clinical assessments in
the first world and the tough clinical environment of Sub
Sahara Africa.
Results:
Surgihoney demonstrates highly potent inhibitory and
cidal activity against a wide range of Gram positive and
Gram negative bacteria and fungi. MIC/MBC’s are
significantly lower than concentrations likely to be
achieved in topical clinical use. Topical concentration
of Surgihoney in wounds is estimated at approximately
500gms/L. Surgihoney MIC/MBC’s for Staph. aureus
are 31 and 125gms/L and Honey Prototype (S3) MIC/
MBC’s 0.12 and 0.24gms/L.
Surgihoney demonstrated a reduction in microbial load
and improved healing in chronic wounds
Objectives:
•  To test the in vitro activity of Surgihoney in comparison to
other proprietary medical antiseptics and natural honeys.
•  To initiate the first clinical evaluations of the licensed
biotechnology honey in as an antimicrobial dressing in chronic
skin lesions.
.
Figure 2: Treating a leg ulcer
with Surgihoney
RESULTS, BENEFITS AND OPPORTUNITIES
  Potential benefits of Surgihoney wound treatment
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Causes greater wound contraction
Promotes the formation of granulation tissue
Promotes epithelialization of wounds
Stimulates tissue growth, synthesis of collagen
Stimulates development of new blood vessels in the bed of wounds
Reduces postoperative adhesion
Reduces oedema
Reduces inflammation
Deodorizes wounds
Promotes moist wound healing
Facilitates debridement
Reduces pain
Reduces bacterial load
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Likely mechanisms of action of Surgihoney 1
High osmolarity
Plant derived flavinoids and aromatic acids
Inactivation of free iron
Formation of oxygen free radicals
Barrier layer
Hydrogen peroxide
TNF-α, IL-1β, and IL-6 release from monocytes
Proliferation and activation of peripheral blood B and T
lymphocytes
Chemotactic for neutrophils
Acidity
Increases nitric oxide and reduces prostaglandin activity
Nutritional composition
Organism
Surgihoney
MIC
MBC
MSSA
MRSA
31
15.6
125
62.5
7.8
7.8
15.6
15.6
Streptococcus Gp B
Streptococcus Gp A
3.9
7.8
15.6
15.6
3.9
1.9
3.9
3.9
Enterococcus
E coli
E coli ESBL
Serratia liquefaciens
Amp C
31
31
31
31
125
62.5
125
7.8
3.9
3.9
62.5
3.9
3.9
62.5
Klebsiella pneumoniae
1:4
125
15.6
7.8
62.5
7.8
0.9
0.9
1.9
Pseudomonas aeruginosa
15.6
15.6
3.9
15.6
0.9
3.9
>
>
15.6
15.6
3.9
3.9
Candida albicans
Day 1
Honey Prototype (S2) Honey Prototype (S3)
MIC
MBC
MIC
MBC
0.24
0.24
0.9
0.24
0.48
0.9
0.9
0.9
3.9
1.9
1.9
1.9
Surgihoney MIC and MBC’s in Gm/L. Wound topical concentration about
500Gm/L
2
2
3
Day 8
0.12
0.12
0.24
Day 1
1
2
3
4
4
1
Day 14
Figure 3: Treatment of an ischaemic ulcer with Surgihoney and eradication of
Pseudomonas sp. (left), Treatment of fractured , infected calcaneum and soft
tissue cavity in a diabetic with Surgihoney (right)
CONCLUSIONS & NEXT STEPS
Surgihoney is highly antimicrobial and appears non-toxic to wounds and possibly
promotes healing. These initial in vitro and clinical evaluations support a prominent
role for this product in soft tissue wound management. Surgihoney wound
treatment may contribute to a reduction in antibiotic use. Current novel
applications under study are in the prophylaxis of surgical wound infection and
vascular line site infection.
2
1
1
Figure 4: Agar diffusion with ESBL Esch coli (top)
and MRSA right: 1 Surgihoney, 2 Manuka 25+, 3
Medihoney, 4 Top grade honey from Yemen
Figure 5: Wound dressing characteristics (left), In vitro activity of Surgihoney with and without silver Aquacel
Ag against MRSA (middle) ,Time kill curve for Surgihoney and modified honey compared with Medihoney
(right)
Reference
Al-Waili NS SK, Al-Ghamdi AA,. Honey for wound healing, ulcers, and burns; data
supporting its use in clinical practice. Thescientificworldjournal 2011: 766-87.