Honey Helps Problem Wounds: "Medihoney" Is Often More Effective Than Antibiotics

A household remedy millennia old is being reinstated: honey helps the treatment of some wounds better than the most modern antibiotics. For several years now medical experts from the University of Bonn have been clocking up largely positive experience with what is known as medihoney. Even chronic wounds infected with multi-resistant bacteria often healed within a few weeks. In conjunction with colleagues from D�sseldorf, Homburg and Berlin they now want to test the experience gained in a large-scale study, as objective data on the curative properties of honey are thin on the ground. The fact that honey can help wounds to heal is something that was known to the Ancient Egyptians several thousand years ago. And in the last two world wars poultices with honey were used to assist the healing process in soldiers' wounds. However, the rise of the new antibiotics replaced this household remedy. 'In hospitals today we are faced with germs which are resistant to almost all the current anti-biotics,' Dr. Arne Simon explains. 'As a result, the medical use of honey is becoming attractive again for the treatment of wounds.' Dr. Simon works on the cancer ward of the Bonn University Children's Clinic. As far as the treatment of wounds is concerned, his young patients form part of a high-risk group: the medication used to treat cancer known as cytostatics not only slows down the reproduction of malignant cells, but also impairs the healing process of wounds. 'Normally a skin injury heals in a week, with our children it often takes a month or more,' he says. Moreover, children with leukaemia have a weakened immune system. If a germ enters their bloodstream via a wound, the result may be a fatal case of blood poisoning. For several years now Bonn paediatricians have been pioneering the use in Germany of medihoney in treating wounds. Medihoney bears the CE seal for medical products; its quality is regularly tested. The success is astonishing: 'Dead tissue is rejected faster, and the wounds heals more rapidly,' Kai Sofka, wound specialist at the University Children's Clinic, emphasises. 'What is more, changing dressings is less painful, since the poultices are easier to remove without damaging the newly formed layers of skin.' Some wounds often smell unpleasant - an enormous strain on the patient. Yet honey helps here too by reducing the smell. 'Even wounds which consistently refused to heal for years can, in our experience, be brought under control with medihoney - and this frequently happens within a few weeks,' Kai Sofka says. In the meantime two dozen hospitals in Germany are using honey in their treatment of wounds. Despite all the success there have hitherto been very few reliable clinical studies of its effectiveness. In conjunction with colleagues from D�sseldorf, Homburg and Berlin, the Bonn medical staff now want to remedy this. With the Woundpecker Data Bank, which they have developed themselves, they will be recording and evalu-ating over 100 courses of disease over the next few months. The next step planned is comparative studies with other therapeutic methods such as the very expensive cationic silver dressings. 'These too are an effective anti-bacterial method,' says Dr. Arne Simon. 'However, it is not yet clear whether the silver released from some dressings may lead to side-effects among children.' Effective bacteria killer It has already been proved that medihoney even puts paid to multi-resistant germs such as MRSA. In this respect medihoney is neck and neck in the race to beat the antibiotic mupirocin, currently the local MRSA antibiotic of choice. This is shown by a study recently published by researchers in Australia. In one point medihoney was even superior to its rival: the bacteria did not develop any resistance to the natural product during the course of treatment. It is also known today why honey has an antiseptic effect: when producing honey, bees add an enzyme called glucose-oxidase. This enzyme ensures that small amounts of hydrogen peroxide, an effective antiseptic, are constantly being formed from the sugar in the honey. The advantage over the hydrogen peroxide from the chemist's is that small concentrations are sufficient to kill the germs, as it is constantly being produced. As a rule much larger quantities of hydrogen peroxide would have to be used, as hydrogen peroxide loses its potency over time. However, in large concentrations it not only damages the bacteria, but also the skin cells. Furthermore, medihoney consists of two different types of honey: one which forms a comparatively large amount of hydrogen peroxide, and another known as 'lepto-spermum honey'. Leptospermum is a species of tree which occurs in New Zealand and Australia. Honey from these trees has a particularly strong anti-bacterial effect, even in a 10% dilution. 'It is not yet known exactly why this is,' Dr. Arne Simon says. 'Probably it is a mix of phenol-type substances which come from the plant and make life particularly difficult for the bacteria in the wound.'

Fewer Heart Patients Need Antibiotics Before Dental Procedures

Based on a review of new and existing scientific evidence, most dental patients with heart disease do not need antibiotics before dental procedures to prevent infective endocarditis (IE), a rare, but life-threatening heart infection.According to revised guidelines from the American Heart Association (AHA) with input from the American Dental Association (ADA), antibiotics are now only recommended for patients at greatest risk of negative outcomes from IE including those with artificial heart valves or certain congenital heart conditions, heart transplant recipients who develop cardiac valve problems, recipients of an artificial patch to repair a congenital heart defect within the past six months and patients with a history of IE.The AHA's latest guidelines were published in its scientific journal, Circulation, in April. The Guidelines apply to a range of medical and dental procedures. The ADA is publishing those portions of the new guidelines relevant to dentistry on its Web site (http://www.ada.org/goto/endocarditis) today and in the June issue of the Journal of the American Dental Association (JADA).For decades, the AHA recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent IE, previously referred to as bacterial endocarditis. IE is an infection of the heart's inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.The ADA participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines are also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.The new guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.The new recommendations apply to many dental procedures, including teeth cleaning and extractions.The guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Tailor-made Antibiotics, Protein Clue

Scientists at the University of York have made a huge leap forward in the search for 'smarter' antibiotics. A research group in the Department of Biology has made a significant advance in understanding how bacteria use proteins to conduct a type of biological warfare. Bacteria like E. coli frequently try to kill each other when resources are scarce using protein antibiotics called colicins, which are potent toxins. The research led by Professor Colin Kleanthous has discovered a critical element in the mode of action of a class of colicins (so-called DNases) that kill cells by destroying their DNA. Though most proteins have a folded structure, DNase colicins are only partially so. The scientists have found that the unfolded part of DNase colicin structure makes its way into an unsuspecting bacterium and blocks a key process that lowers the cell's defences and allows the toxin to enter. Professor Kleanthous said: "Antibiotic resistance is on the increase throughout the world. Understanding how bacteria have evolved to kill each other with protein toxins might offer ways of constructing new, tailor-made antibiotics that target particular microorganisms." Researchers are now trying to establish what it is about this blocking mechanism (which they've christened 'competitive recruitment') that lowers the cells' defences toward the colicin.

Controlling Antibiotics And Antibiotic Resistance In Hospitals

In one of the first national studies on guidelines that control antibiotics and antibiotic resistance in hospitals, researchers from the Indiana University School of Medicine, the Regenstrief Institute, Inc. and the Richard Roudebush Veterans Administration Medical Center report that hospitals that follow national guidelines on controlling antibiotic use have lower rates of antibiotic resistance. In a study published in the October issue of Infection Control and Hospital Epidemiology, the researchers studied four major types of antibiotic resistance at almost 450 hospitals, looking at what each hospital did to control antibiotic use and how this affected the rate of antibiotic resistance. "We saw in this study, as in other work we have done, that antibiotic resistance is increasing rapidly. This increase is seen in all types of hospitals across the country - large and small, teaching and non-teaching, VA and non-VA," said Bradley N. Doebbeling, M.D., M.Sc., who led the study. He directs the IU Center for Health Services and Outcomes Research at the Regenstrief Institute and the IU School of Medicine. He also directs the VA Center for Implementing Evidence-Based Practice. The study looked at measures to prevent development of antibiotic resistance as well as ways to stop its spread. The researchers reported that if hospitals implemented specific measures to control the use of antibiotics they were more likely to have succeeded in controlling antibiotic resistance. Surprisingly, use of information technology didn't seem to have an impact. "We think that's because so few hospitals have the necessary technology available to support decisions related to prescribing antibiotics such as start and stop rules and how to use the best drug," said Dr. Doebbeling. Prescription of antibiotics fall into three categories (1) preventive, often administered before or during surgery; (2) empiric - prescribed before the physician knows the specific nature of the bacteria; and (3) targeted - prescribed after bacterial culture results identify the bacteria actually causing the infection. The study found that if a hospital had implemented measures to control the duration of administration of an empiric antibiotic, the institution had lower antibiotic resistance rates. Having a restricted hospital formulary that limited the antibiotics available in the hospital was associated with a higher prevalence of antibiotic resistance, while simply limiting broad spectrum drugs helped prevent resistance. "We think this may be because wrong decisions are made about which antibiotics are made available. Other studies have shown evidence that restricting formularies to previously effective antibiotics can actually help control antibiotic resistance," said Dr. Doebbeling.

Are Antibiotics Being Used For Too Long?

Taking antibiotics for three days is just as effective for community acquired pneumonia as continuing treatment for the recommended 7-10 days, finds a study in this week's BMJ. Shorter treatment can also help contain growing resistance rates. The study raises questions about the optimal duration of antibiotic therapy for common infections. Community acquired pneumonia is one of the most important indications for antibiotic prescriptions in hospitals. But a lack of evidence to support short course therapy means it has become accepted practice to continue treatment for days after symptoms have improved. Researchers in the Netherlands compared the effectiveness of discontinuing treatment with amoxicillin after three days or eight days in adults admitted to hospital with mild to moderate-severe community acquired pneumonia. 119 patients who substantially improved after the conventional three days' treatment with intravenous amoxicillin were randomly assigned to oral amoxicillin (63 patients) or placebo (56 patients) three times daily for five days. Patients were assessed at days 7, 10 (two days after treatment ended), 14, and 28. In the three day and eight day treatment groups, the clinical success rate at day 10 was 93% for both, and at day 28 was 90% compared with 88%. Both groups had similar resolution of symptoms, x-ray results, and length of hospital stay. These findings show that discontinuing amoxicillin treatment after three days is not inferior to discontinuing it after eight days in adults with mild to moderate-severe community acquired pneumonia who have substantially improved after an initial three days' treatment, say the authors. A shorter duration of treatment can also help to reduce overall antibiotic consumption and resistance rates for respiratory infections, they conclude. This study suggests that current guidelines recommending 7-10 days should be revised, says Dr John Paul from the Royal Sussex County Hospital, in an accompanying commentary. Not only does the study yield strong evidence in favour of short course therapy for a subset of patients with community acquired pneumonia, but also shows how centres can cooperate to tackle longstanding areas of uncertainty in clinical microbiology and infectious diseases, he writes. Many other common clinical situations would repay the efforts of comparable approaches.

Targeted Antibiotics Lead To Prolonged Improvement In IBS Symptoms

Researchers at Cedars-Sinai Medical Center have found that a nonabsorbable antibiotic - one that stays in the gut - can be an effective long-term treatment for irritable bowel syndrome (IBS), a disease affecting more than 20 percent of Americans.The study, which appears in the October 17 issue of the Annals of Internal Medicine, is the first to demonstrate benefits from antibiotic use even after the course of treatment has ended, supporting previously published research that identified small intestine bacterial overgrowth as a cause of the disease.The randomized, double-blind, placebo-controlled study involved 87 participants, all of whom met specific multinational guidelines for diagnosis of IBS. They received 400 mg of the antibiotic rifaximin three times a day for 10 days or a placebo. Participants completed an extensive symptom questionnaire at the start of the study and then weekly for 10 weeks following treatment. The questionnaire measured the severity of nine symptoms (abdominal pain, diarrhea, constipation, bloating, urgency, incomplete evacuation, mucus, sense of incomplete evacuation, and gas). Patients were also asked to provide a percent global improvement from 0 to 100 percent in their overall IBS symptoms.Researchers found that the rifaximin not only led to significant improvement in global IBS symptoms during the 10 days it was administered, but also that the benefit continued for the 10 weeks of follow up when no antibiotic was given, showing sustained benefit."The fact that the benefit of the targeted antibiotic continued even after it was stopped provides evidence that the antibiotic was acting on a source of the problem: excess bacteria in the gut," said Mark Pimentel, M.D., director of the GI Motility Program at Cedars-Sinai and the study's principal investigator. "This finding offers a new treatment approach - and a new hope - for people with IBS."Irritable Bowel Syndrome is one of the top 10 most frequently diagnosed conditions by U.S. physicians. It is an intestinal disorder that causes abdominal pain, cramping, bloating and diarrhea and/or constipation and is a long-term condition that usually begins in early adult life. Episodes may be mild or severe and may be exacerbated by stress. IBS is more common in women than in men."While this study being released today demonstrates that the non-absorbed antibiotic rifaximin has great promise in the clinical improvement of IBS, more research is needed," said Pimentel. "Next steps include multi-center studies to further assess short- and long-term benefits of this drug. Tests comparing rifaximin to other types of antibiotics that have been used to treat the disease should also be conducted."Because the cause of IBS has been elusive, treatments for the disease have historically focused on reducing its symptoms - diarrhea and constipation - by giving medications that either slow or speed up the digestive process. In The American Journal of Gastroenterology (Dec. 2000), Pimentel linked bloating, the most common symptom of IBS, to bacterial fermentation by giving lactulose breath tests to participants. The test, which monitors the level of hydrogen and methane (the gases emitted by fermented bacteria) on the breath, showed evidence that small intestine bacteria overgrowth may be a causative factor in IBS.Participants in the current Annals study also took the breath tests, which showed similarly increased levels of hydrogen and methane.Rifaximin, an antibiotic that is FDA-approved for travelers' diarrhea in this country, is made by Salix Pharmaceuticals, Inc. Funding for the study was also provided by Salix. The discovery related to the use of rifaximin for IBS was made at Cedars-Sinai by Pimentel. Cedars-Sinai holds patent rights to this discovery and has licensed rights to the invention to Salix.Other authors from Cedars-Sinai include Sandy Park, James Mirocha, and Yuthana Kong. Sunanda V. Kane from the University of Chicago also participated in the study.

Antibiotic Resistant Bacteria In Poultry Could Threaten Human Health

A surprising finding by a team of University of Georgia scientists suggests that curbing the use of antibiotics on poultry farms will do little - if anything - to reduce rates of antibiotic resistant bacteria that have the potential to threaten human health. Dr. Margie Lee, professor in the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antibiotic-free farms and even those raised under pristine laboratory conditions have high levels of bacteria that are resistant to common antibiotics. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs. "The resistances don't necessarily come from antibiotic use in the birds that we eat," Lee said, "so banning antibiotic use on the farm isn't going to help. You have to put in some work before that." Lee and her team sampled droppings from more than 140,000 birds under four different conditions: 1.) commercial flocks that had been given antibiotics; 2.) commercial flocks that had not been given antibiotics; 3.) flocks raised in a lab that had been given antibiotics; and 4.) flocks raised in a lab that had not been given antibiotics. The researchers examined levels of antibiotic resistance in normal intestinal bacteria that do not cause human illness and - in a companion study published in May in the same journal - also examined levels of drug resistant campylobacter bacteria, a common foodborne cause of diarrhea, cramping and abdominal pain. They found that even birds raised in the pristine laboratory conditions had levels of antibiotic resistance levels comparable to what was seen on farms that used antibiotics. Even when the levels were lower, Lee adds, they were still well above the reasonable comfort zone for antibiotic resistance - roughly five to 10 percent. Seventy-three percent of the bacteria from one flock in the antibiotic-free commercial group were resistant to the drug oxytetracycline, for example, while 90 percent were resistant to the drug in a commercial flock that used antibiotics. Ninety-seven percent were resistant in the experimental flock that was given antibiotics, while forty-seven percent were resistant in the experimental group that was not given antibiotics. Strikingly, they even found bacteria resistant to streptomycin, a common human antibiotic that is rarely used in poultry and was not used on the farms the researchers studied. Bacteria swap genes relatively easily, and Lee explained that the concern is that drug resistance genes from bacteria that infect poultry could be passed on to bacteria that cause human illness. With these resistance genes, human bacterial illness could become harder to treat. These concerns led the European Union to ban the use of antibiotics for growth promotion in chickens in 2006. In 2005, the U.S. Food and Drug Administration banned the use of the drug Baytril - the brand name for enrofloxacin, a fluoroquinolone antibiotic - in poultry, citing concerns that it could lead to resistance in human antibiotics such as Cipro, also a fluoroquinolone. Several advocacy groups are pushing for a more comprehensive animal antibiotic ban in the United States, but Lee said her research plus the evidence from the Baytril ban suggests that approach won't help. "They banned Baytril in 2005, and if you look at Baytril resistance in campylobacter now it's essentially unchanged," Lee said. In previous studies, Lee has tried to recreate experimentally conditions that should lead to the swapping of resistance genes among bacteria. Lee said these events - known as the horizontal transfer of genes - do occur, but they may not be as common as initially thought. What may be driving the antibiotic resistance that Lee has observed in her studies is what's known as vertical transfer - from parent to child - of bacteria carrying resistance genes. In short, the birds may come to the farm harboring antibiotic resistant bacteria. "This issue of antibiotic resistance is more complicated than once thought," Lee said. "These findings suggest that banning antibiotics at the farm level may not be as effective as assumed. We need further studies to identify which management practice would be effective" Lee stresses that for consumers, the advice on poultry is the same that it's always been. Cook meat thoroughly and use proper food handling and preparation techniques - washing your hands regularly and keeping other foods away from raw chicken, for example - to minimize the risk of illness. "All foods have the potential to contain pathogens - all of them," Lee said. "There's no substitute for good food handling and preparation."