Pure manuka honey with the brand name Activon - an alternative to systemic antibiotic therapy in the prevention of recurrent infections in cancer wounds?
Experience from the use of Activon in the treatment of malignant ulcerations, 27 patients. The
wound outpatients'department, Radiumhemmet, Karolinska Hospital. Ingrid Rostrcim-Bjiirn,
oncology nurse specialising in malignant tumour wounds.
In Grandma’s days... There was a conference in 2005 at which a number of exhibitors displayed wound-related therapeutic products and wound-dressing materials. A question was directed at me from one of the exhibition stands: Do you know about the bactericidal effect of Manuka honey?
A memory from my childhood came to mind: I had come off my bicycle and grazed my knee the day before I saw Grandma. The wound was sore, it had become infected and it was producing pus.
When Grandma saw my knee she said “Come on, let’s clean up that wound and put some honey on - that will make it better...”
She cleaned out the wound with water and put on a linen bandage with honey - straight from the jar. The next morning the wound was clean and presumably healed quickly, because I do not remember having any more trouble with it. There was just a scar left... for a long time. Grandma was a clever woman - she lived in the country and knew a lot about “household remedies”. She certainly would not have been able to explain why honey had a bactericidal effect – all she knew was that it “always helped”...But every now and then during my twenty years as a nurse specializing in wounds I have found myself wondering why? Was there any explanation other than the sugar?
Then, at the conference, I came into contact with Activon, pure manuka honey from New Zealand. With documentation from “The Honey Book”, “HONEY A modern wound management product”, and especially chapter 2 “The antimicrobial activity of honey”, which provides interesting information on the composition of honey and helps to answer my question “why”. The event itself could not have happened at a better time.
At the time we had a patient with a large ulcerating primary breast cancer, which proved resistant to treatment with chemotherapy or systemic antibiotics. She was a keen advocate of alternative medicine and had complete confidence in her naturopath! The bacterial infection in the degrading tumour tissue produced a strong odour and added to our frustration at not being able to give any treatment. Local antibacterial therapy was the only option for which we could obtain approval, and initial treatment against anaerobic bacteria was initiated using local antibiotic therapy, with good results. The patient then agreed to try out treatment using Manuka honey, Activon, with a view to minimizing the subsequent bacterial attacks that we knew would develop. During a period of a little over two months, no infection developed.
Background
For cancer patients with malignant tumour wounds, infection is a major and recurrent problem that impacts significantly on the patient’s quality of life and, in the worst cases, has a negative effect on the antitumour therapy.
Critical colonization/infection results in increased wound secretion, an increased tendency to haemorrhage and worsened odour. The effects of the cancerous disease and the antitumour therapy on the patient’s immunological defence involve an increased risk of sepsis. Wound infections should always be treated initially with systemic antibiotics in order to treat the acute phase.
Repeated infection treatments using systemic antibiotics are usually required in order to keep the degrading tumour tissue free from infection.
However, systemic treatment affects the intestinal flora amongst other things, resulting in diarrhoea. For patients with malnutrition, this means an additional negative effect on their general status.
It would spare the patient considerable discomfort if a local therapy could be used to keep the surface of the malignant tumour free from critical colonization/infection.
This is the challenge, since wounds often require long-term treatment at the patient’s home, with the support of several care providers.
Exophytic breast cancer growth - 3 weeks after full-dose radiotherapy.
Activon treatment once a day: Wound culture shows normal skin flora!
For patients who, for various reasons, cannot or do not want to accept systemic antibiotic therapy, local therapy aimed at combating wound infections has been the only option to be accepted by the patient.
Aim
To establish whether local treatment using pure manuka honey with the brand name Activon reduces the risk of critical colonization/infection and thereby the need for systemic antibiotic therapy.
Activon is supplied in a tube, and it has a somewhat viscous consistency which becomes less viscous on contact with body heat, making it easy to cover the wounds despite the irregular growth and structure of the ulcerating tumours. Its consistency means that it goes a long way.
Method
Wound treatment using Activon was initiated at the wound outpatients’ department in consultation with the attending oncologist and was continued in the patient’s home, in collaboration with the nurse as part of home nursing, or the district nurse as part of primary care.
Patients returned to the wound outpatient’s department at Radiumhemmet once a week or every other week for follow-up and photodocumentation.
Wound cultures were taken on a random basis.
Some examples of malignant tumour wounds treated using Activon:
Fig. 1
Breast cancer. Undergoing chemotherapy, prior to radiotherapy. Local treatment using Activon. Wound culture taken from the edge of the yellow necrosis showed normal skin flora.
Fig. 2
The same patient three weeks after full-dose radiotherapy.
Local treatment using Activon: wound culture taken from the edge of the yellow necrosis showed Staph. aureus, beta haemolytic group G streptococci and Proteus mirabilis but no symptoms of infection! Good wound healing.
Fig. 3
Squamous cell carcinoma. Skin graft two weeks after radiotherapy.
Penicillin treatment started three days previously. Activon started after cleaning of the wound area. Wound treatment twice a day for 4 days, thereafter once a day.
Symptom-free after 4 days. Entirely healed after 15 days. Skin graft intact.
Fig. 4
Soft tissue sarcoma of the heel. Antitumoral therapy by means of chemotherapy followed by radiotherapy. Local treatment using Activon: free from infection in 2 months 17 days. This was followed by progression of the disease, resulting in surgery.
Patient material
Age distribution: 38-76. Mean age: 58
27 patients were treated using Activon, for various periods.
24 patients were followed up at the wound outpatient’s department, where the treatment could be assessed.
All had ulcerations with a wound surface area of > 8cm, 13 superficial, 11 deep.
All patients were undergoing antitumoral therapy.
Distribution of tumour groups:
| Breast cancer | 11 |
| Head-neck cancer | 2 |
| Gynaecological cancer | 3 |
| Squamous cell carcinoma | 3 |
| Basal cell carcinoma | 2 |
| Rectal cancer | 1 |
| Malignant melanoma | 2 |
Results
5 of the patients who were treated using Activon developed wound infections due to progression of their cancer and were therefore treated using systemic antibiotics.
19 of the patients did not show (for at least 3 weeks and in most cases 18 weeks) any signs of critical colonization or infection during the periods in which Activon treatment was provided.
Wound cultures sometimes showed bacterial growth, though without any signs of infection.
The longest treatment period using Activon is 4 months and 16 days, and this is also the best documented, since the patient refused systemic antibiotic therapy.
During the treatment period there were no symptoms of infection in the form of fever or odour.
Summary
Local treatment of malignant tumour wounds using Activon pure manuka honey produced surprisingly good results. During the treatment period it effectively reduced the risk of critical colonization/infection and thereby the need for systemic antibiotics. It was possible to reduce wound treatment events for most patients to every second or third day.
NB: In view of their right to anonymity I have chosen to omit the initials and birth years of the patients treated with manuka honey, since this article does not claim to be a scientific study.
Literature
The Honey Book, “HONEY, A modern wound management product”.
Richard White PhD, Department of Tissue Viability, Aberdeen Royal Infirmary, Scotland
Rose Cooper BSc, PGCE is Principal Lecturer in Microbiology, University of Wales Institute Cardiff, UK
Peter Molan BSc, PhD is Professor of Biological Sciences and Director of the Honey Research Unit, University of Waikato, New Zealand.