The Anti-Inflammatory and Antibacterial Action of Nanocrystalline Silver and Manuka Honey on the Molecular Alternation of Diabetic Foot Ulcer: A Comprehensive Literature Review

Table 4

The clinical evidence on manuka honey topical dressings on DFU.

Number	Author	Nature of study	Number of subjects	Intervention	Funding	Major findings	Comments
[103]	Gethin and Cowman, 2005	Case series	8	Manuka honey	Not stated	A mean initial wound size of 5.62 cm for all wounds decreased to 2.25 cm at the end of the four-week treatment period.	There was a high risk of detection bias because the outcome assessors were not blinded.; There was unclear risk of selection bias because no inclusion and exclusion criteria were mentioned.; Only one out of eight ulcers was DFU.
[104]	Al Saeed, 2013	RCT	59	Manuka honey impregnated dressing versus tulle	Self-funded	The percentage of ulcers healed in the honey group (61.3%) was significantly higher than in the control group (11.5%).; There were significant fewer toe amputations in the honey group (9.7%) compared with the control group (34.6%).	There was an unclear risk of selection and performance bias because randomization, concealment, and double blinding were not reported.; Inclusion and exclusion criteria were not clearly stated.; The use of any antibiotics and any adverse events were not reported.
[105]	Kamaratos et al., 2014	RCT	63	Manuka honey tulle versus saline soaked gauze	Self-funded	The two groups did not differ significantly in the percentage of ulcers healed at the 16-week follow-up session.; The mean healing time in the honey group of 31 ± 4 days was significantly shorter than the 43 ± 3 days for the control group.	There was an unclear risk of detection bias because the blinding of the outcome assessors was not clearly reported.; There was a high risk of selection bias because no true randomization was performed.; Inclusion and exclusion criteria were not clearly reported.; Adverse effects were not reported.