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Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial

Johnson, David W., Badve, Sunil V., Pascoe, Elaine M., Beller, Elaine, Cass, Alan, Clark, Carolyn, de Zoysa, Janak, Isbel, Nicole M., McTaggart, Steven, Morrish, Alicia T., Playford, E. Geoffrey, Scaria, Anish, Snelling, Paul L., Vergara, Liza A., Hawley, Carmel M. and HONEYPOT Study Collaborative Group (2014). Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. Lancet Infectious Diseases,14(1):23-30.

Document type: Journal Article
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IRMA ID 11035xPUB42
Title Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial
Author Johnson, David W.
Badve, Sunil V.
Pascoe, Elaine M.
Beller, Elaine
Cass, Alan
Clark, Carolyn
de Zoysa, Janak
Isbel, Nicole M.
McTaggart, Steven
Morrish, Alicia T.
Playford, E. Geoffrey
Scaria, Anish
Snelling, Paul L.
Vergara, Liza A.
Hawley, Carmel M.
HONEYPOT Study Collaborative Group
Journal Name Lancet Infectious Diseases
Publication Date 2014
Volume Number 14
Issue Number 1
ISSN 1473-3099   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84890430823
Start Page 23
End Page 30
Total Pages 8
Place of Publication United Kingdom
Publisher The Lancet Publishing Group
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus.

Methods
In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459.

Findings
Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83–1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05–3·24; p=0·03) and peritonitis (2·25, 1·16–4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions.

Interpretation
The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections.
DOI http://dx.doi.org/10.1016/S1473-3099(13)70258-5   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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