molan - using honey in wound care

8/10/2019 Molan - Using Honey in Wound Care

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Using honey in wound care

P. C.Molan

Professor of Biological Sciences, and Director of the Honey Research Unit, Department of Biological

Sciences, University of Waikato, Hamilton, New Zealand

Email:pmolan @wa ik a to.ac .nz

Honey is primarily a herbal product with some modifications that are made by thebees that process the nectar or sap collected from the plants to store as honey. Thetypes of phytochemicals present in a honey depend on the plant source of thehoney. The hydrogen peroxide that is formed in honey by an enzyme the bees add,and sometimes also particular phytochemicals from the nectar or sap, give honeyantibacterial activity that is sufcient to be e!ective in clearing infection from

wounds. The phytochemicals also give honey its antioxidant activity which is alsoimportant in wound care, acting to decrease inflammation. Honey has been used in

wound care since ancient times, but was displaced from use by the advent ofantibiotics. "ith the widespread resistance to antibiotics developing in bacteria, itis now being #rediscovered#, and in many cases is proving to give better results thanmodern wound$care products. %t has the advantage of providing moist healingconditions without the ris& of bacterial growth, preventing adhesion of dressings to

wound tissues, giving rapid removal of pus, dead tissue and debris from wounds,decreasing inflammation and thus decreasing swelling, pain and exudation of serumand preventing scarring, and speeding up the growth of tissues to repair wounds.

Menggunakan madu dalam perawatan luka

P. C. MolanProfesor Ilmu Biologi, dan Direktur Unit Penelitian Madu, Departemen Biologi

Sciences, University of aikato, !amilton, Selandia Baru

"mail# pmolan$waikato.ac.n%

Madu terutama produk &er'al dengan 'e'erapa modi(kasi yang di'uat ole& le'a&yang memproses nektar atau geta& yang dikumpulkan dari tanaman untukmenyimpan madu. )enis*+enis p&ytoc&emical &adir dalam madu tergantung padasum'er tanaman madu. !idrogen peroksida yang ter'entuk dalam madu ole& en%imle'a& menam'a&kan, dan p&ytoc&emical kadang*kadang +uga k&usus dari nektaratau geta&, mem'erikan aktivitas anti'akteri madu yang cukup efektif dalammem'ersi&kan infeksi dari luka. itokimia +uga mem'erikan madu aktivitasantioksidan yang +uga penting dalam perawatan luka, 'ertindak untuk mengurangiperadangan. Madu tela& digunakan dalam perawatan luka se+ak %aman kuno, tapipengungsi dari penggunaan ole& munculnya anti'iotik. Dengan resistensi luaster&adap anti'iotik 'erkem'ang pada 'akteri, sekarang sedang -menemukankem'ali-, dan dalam 'anyak kasus ter'ukti mem'erikan &asil yang le'i& 'aikdaripada produk*perawatan luka modern. Ini memiliki keuntungan dari mem'erikankondisi penyem'u&an lem'a' tanpa risiko pertum'u&an 'akteri, mencega& ad&esidressing luka +aringan, mem'erikan peng&apusan cepat nana&, +aringan yang matidan puing*puing dari luka, mengurangi peradangan dan se&ingga mengurangipem'engkakan, nyeri dan eksudasi serum dan mencega& +aringan parut, dan

mempercepat pertum'u&an +aringan untuk memper'aiki luka.
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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Introduction

Although classified as an anima l p roduc t , hone y is primarily aherbal product with some modifications thatare made by the animals bees! that processit. "ees produce honey by gathering nectarfrom plants and, occasionally, by gatheringsap, such as when honeydew is gathered!,adding some enzymes to it, thene#aporating off a lot of the water to create asuper$saturated sugar solution that can bestored without spoilage. %ne of the enzymes

added, transglucosylase, catalyses thehydrolysis of the sucrose in the nectar orsap! to form a mi&ture of glucose andfructose, this mi&ture being more solublethan the original sucrose so that theconcentrated solution has too high anosmolarity for microorganisms to sur#i#e init.

Another enzyme added, glucose o&idase,catalyses the o&idation of some of theglucose to form gluconic acid the resulting

low p' inhibiting microbial growth! and theby$product hydrogen pero&ide which kills#egetati#e cells and spores ofmicroorganisms so that the honey stored inthe capped cells of honey$comb is usuallysterile. (he enzyme which forms hydrogenpero&ide becomes inacti#e as the watercontent becomes low when the nectar)sap iscon#erted to honey by e#aporation of water,but becomes acti#e again if the honey getsdiluted.Penda&uluanSe'ua& animalproductlt&oug&classi(edasan, &oneyis terutamaproduk &er'al dengan 'e'erapamodi(kasi yang di'uat ole& &ewan le'a&/yang memprosesnya. 0e'a&meng&asilkan madu denganmengumpulkan nektar dari tanaman dan,kadang*kadang, dengan mengumpulkangeta&, seperti ketika melon dikumpulkan/,menam'a&kan 'e'erapa en%im untuk itu,kemudian menguap dari 'anyak air untukmenciptakan solusi super +enu& gula yang

dapat disimpan tanpa pem'usukan. Sala&satu en%im ditam'a&kan,transglucosylase, mengkatalisis &idrolisissukrosa dalam nektar atau geta&/ untukmem'entuk campuran glukosa danfruktosa, campuran ini men+adi le'i&muda& larut daripada sukrosa asli

se&ingga larutan pekat memiliki terlalutinggi osmolaritas untuk mikroorganismeuntuk 'erta&an &idup di dalamnya.

"n%im lain menam'a&kan, oksidaseglukosa, mengkatalisis oksidasi 'e'erapaglukosa untuk mem'entuk asam glukonatp! renda& yang di&asilkan meng&am'atpertum'u&an mikro'a/ dan &idrogen

peroksida ole&*produk yang mem'unu&sel*sel vegetatif dan spora darimikroorganisme se&ingga madu disimpandalam sel tertutup madu*sisir 'iasanyasteril. "n%im yang mem'entuk &idrogenperoksida men+adi tidak aktif se'agaikadar air men+adi renda& ketika nektar 1geta& diu'a& men+adi madu denganpenguapan air, tetapi men+adi aktif lagi+ika madu akan diencerkan.

(he antimicrobial properties of honeywhich preser#e the stored nectar)sap forthe bees also make honey a goodantibacterial agent for medical use. "ut aswell as ha#ing the antimicrobial propertiesthat deri#e from its high osmolarity, itsacidity and its production of hydrogenpero&ide, honey has therap euticproperties that deri#e from the manyphytochemicals that are in the nectar or sapgathered by the bees and also get

concentrated up when water is .e#aporated tomake honey. (he types of phytochemicals

present in a honey depend on the types ofplants from which the honey is deri#ed: theuni*ue composition of


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honey from each source is what gi#esdifferent types of honey their characteristiccolours, +a#ours and aromas. (hephytochemicals also in+uence the stability ofglucose o&idase in honey, thus honeys fromdifferent sources ha#e different le#els ofproduction of hydrogen pero&ide.

Sifat antimikroba dari madu yang melestarikan

disimpan nektar / getah untuk lebah madu juga

membuat agen antibakteri yang baik untukpenggunaan medis. Tapi serta memiliki sifat

antimikroba yang berasal dari osmolaritas tinggi,

keasaman dan produksi hidrogen peroksida,

madu memiliki sifat therap eutic yang berasal

dari berbagai phytochemical yang berada di

nektar atau getah yang dikumpulkan oleh lebah

dan juga mendapatkan terkonsentrasi ketika air

.evaporated untuk membuat madu. Jenis-jenis

phytochemical

hadir dalam madu tergantung pada jenis tanaman

yang madu berasal: komposisi unik

madu dari masing-masing sumber adalah apa

yang memberi berbagai jenis madu arna

karakteristik mereka, rasa dan aroma. !itokimia

juga mempengaruhi stabilitas oksidase glukosa

dalam madu, sehingga madu dari sumber yang

berbeda memiliki berbagai tingkat produksi

hidrogen peroksida.

(he Ancient reeks were aware of the

di-erences between honeys in respect oftheir therapeutic #alues, and wrote of someparticular types of honey being the best fortreating wounds and ulcers unther, 1/0Aristotle, 11!, and another type beingbest for treating sunburn unther,1/0!. 3uch knowledge is also seen inpresent$day folk medicine around the world4olan, 1!. (his is in line with research5ndings that honey can #ary as much as1$fold in the potency of its antibacterialacti#ity. (he literature on the nature of theantibacterial components of honey and the

reasons for the #ariability in the le#el ofacti#ity has been re#iewed in detail 4olan,12a 12b!.

Ancient and modern usage of honey in wound

care

6n ancient history the Egyptia ns,Assyrians, 7hinese, reeks and 8omans allused honey, in combination with herbs andon its own, to treat wounds 9umla and

ulat,1;!. Aristotle /


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an end as increasing numbers of bacterial strains develop

resistance to antibiotics.

2uno 3unani menyadari per'edaanantara madu dalam &al nilai*nilaiterapeutik mereka, dan menulis'e'erapa +enis tertentu madu men+adiyang ter'aik untuk mengo'ati luka dan'orok 4unt&er, 56789 :ristoteles, 565;/,dan +enis lain yang ter'aik untukmengo'ati sun'urn 4unt&er,5678/. Pengeta&uan terse'ut +ugaterli&at pada masa kini o'at rakyat diseluru& dunia Molan, 5666/. !al inise+alan dengan &asil penelitian 'a&wamadu dapat 'ervariasi se'anyak5;; kali lipat potensi aktivitasanti'akteri. 0iteratur tentang sifat darikomponen anti'akteri madu dan alasanuntuk varia'ilitas dalam tingkat aktivitas

tela& diulas secara rinci Molan, 566umla dan 0ulat,56?6/, mungkin karena -era anti'iotik-akan datang ke

International )ournal of Clinical:romaterapi


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Pengecualian adala& 'a&wa di sala& satu u+ico'a terkontrol secara acak, padagelandangan, awal sayatan tangensial'eda& ditemukan le'i& efektif daripada'erpakaian luka dengan madu untukkontrol infeksi, tetapi aspek*aspek lain yangle'i& 'aik dengan madu. 2arena madutidak diu+i untuk tingkat aktivitasanti'akteri, kontrol miskin infeksi mungkin

karena madu yang digunakan adala&aktivitas renda&. 0aporan ini +ugamenun+ukkan 'a&wa madu le'i& efektifdi'andingkan kontrol dalam mem'antupenyem'u&an luka di 5 u+i co'a pada total@77 luka pada &ewan perco'aan, dan'a&wa &al itu mem'eri &asil yang sangat'aik dalam sepulu& pu'likasi yangmelaporkan pada 'e'erapa kasus dengantotal


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a moist non -adherent environment. # n an e+periment

carried out on infection-free ounds on mice, comparing

honey ith a control moist dressing )saline*, honey gave a

$$4 greater e+tent of epithelialisation and a 0%4 greater

thickness of granulation tissue )ergman et al., $%63*.

'ound healing occurs by granulation tissue filling in any

cavity, and epithelial cells migrating across this from the

surviving epithelium at the margin of the ound to create

ne skin cover. 7ranulation tissue consists of granules of

fibroblasts groing around buds of ne capillaries here

they form. The supply of o+ygen is the rate-limiting factor

for groth of repair tissue in ounds. Stimulation of

angiogenesis )groth of ne capillaries* by honey has also

been observed in histological studies of e+perimental ounds

in animals )7upta et al., $%%"8 9umar et al., $%%3*. The

acidity of honey )typically p 3.2-* ould also help ith

o+ygenation, as acidification of ounds speeds the rate of

healing by increasing the release of o+ygen from

haemoglobin )9aufman et al., $%62*.

arga yang sangat cepat penyembuhan luka terlihat

ketika berpakaian dengan madu adalah karena lebih

dari sekedar itu menciptakan

#nternational Journal of (linical &romaterapi "0

5ol 3, ;disi "

lembab ada lingkungan n -adherent. &ku n

percobaan dilakukan pada luka bebas infeksi pada

tikus, membandingkan madu dengan kontrol saus

lembab )saline*, madu memberikan

Sejauh $$4 lebih besar dari epithelialisation dan

ketebalan 0%4 lebih besar dari jaringan granulasi

)ergman et al., $%63*.


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products are being brought on the market hich in various

ays inhibits the activity of these damaging proteases. The

indications from clinical observation are that honey also

orks in this ay, but the mechanism of this is not yet

knon. #t could be through killing the bacteria causing the

inflammation, through its anti-inflammatory activity )see

belo*, or through its antio+idant components preventing

the o+idative activation of the dormant proteases. ut at the

same time, hilst preventing digestion of connective tissue,

honey someho gives proteolytic activity that digests the

fibrin that holds pus on a ound, and thus very rapidly

gives clean ounds though this autolytic debridement. #t

may be that honey someho activates the plasminogen that

is in ound tissues to give plasmin, a protease that acts on

fibrin, but this remains to be investigated. ut hatever

the mechanism, the debriding action on ounds is a very

valuable feature, as debriding removes material that is

harbouring a large pool of bacteria producing substances

that inhibit healing of the ound. :ktivitasanti'akteri madu sangat penting dalam

perawatan luka. Banyak penelitian yangtela& dipu'likasikan menun+ukkan potensikegiatan ini ter&adap 'er'agai +enis'akteri yang menye'a'kan infeksi lukatela& ditin+au Molan,


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perawatan luka Molan,


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is seen in the potency of the antibacterial activity of

honey. This has also been the case in some of the

honey ound-care products on sale. ut other companies

have based their products on !eptospermum scoparium,

manuka honey from =e >ealand, or a similar honey

from &ustralian !eptosperinwn species, ith a high level

of a uni?ue )as yet unidentified* phytochemical

antibacterial component. The major advantage of using

this type of honey is that the phytochemical antibacterialfactor is not affected by the en@yme catalase that is

present in the cells and serum in ounds and hich

breaks don hydrogen pero+ide, hich ould destroy a

large part of the antibacterial activity in other types of

honey. Tubes of this type of honey, and ound

dressings made from it, are available from several

companies as sterile products registered for use as medical

ound dressings.

#f the various other therapeutic bioactivities that honey

has are due to phytochemicals then these too are likely to

vary in potency beteen different honeys. &t present honeyon sale for ound care is not selected for levels of

activities other than antibacterial activity, but research is

under ay that should lead to the selection of honeys that

have the highest levels of the other activities that are

beneficial in ound care.

erlihat dalam potensi aktivitas antibakteri madu. #ni

uga telah terjadi di beberapa produk peraatan

uka madu dijual. Tetapi perusahaan-perusahaan

ain telah berdasarkan produk mereka di

Deptospermum scoparium, madu manuka dari

elandia aru, atau madu yang sama dari spesiesDeptosperinn &ustralia, dengan tingkat tinggi

omponen antibakteri yang unik )yang belum

eridentifikasi* fitokimia. 9euntungan utama

menggunakan jenis madu adalah baha faktor

ntibakteri fitokimia tidak terpengaruh oleh en@im

atalase yang hadir dalam sel-sel dan serum pada

uka dan yang memecah hidrogen peroksida, yang

kan menghancurkan sebagian besar aktivitas

ntibakteri dalam jenis madu. Tabung jenis ini

madu, dan pembalut luka terbuat dari itu, tersedia

ari beberapa perusahaan sebagai produk sterilerdaftar untuk digunakan sebagai dressing luka

medis.

ika berbagai bioactivities terapi lain yang madu

memiliki disebabkan fitokimia maka ini juga

enderung bervariasi dalam potensi antara madu

ang berbeda.

molan - using honey in wound care

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