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Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis
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  • Published on:
    The issues with promoting honey over antibiotics
    • Lucy Dale, Final Year Medical Student Barts & the London School of Medicine & Dentistry
    • Other Contributors:
      • Ellie V Evans, Final Year Medical Student

    To the editor,

    We read the article “Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis” with great interest. The need to discover effective remedies for symptomatic relief of upper respiratory tract infections (URTIs), while preventing further antimicrobial resistance developing is indeed paramount. However, after reading the article in detail, we noted a number of discrepancies which we feel must be highlighted and addressed.

    Firstly, we believe that the article is misleading, and if read as a lay member of the public, or indeed by a sensationalist news outlet, incorrect and potentially health-threatening conclusions may be drawn and promoted. Firstly, the abstract focuses on positing honey as an alternative to antibiotics for the symptomatic relief of URTIs. The authors highlight that honey possesses antimicrobial properties, with the conclusion of the abstract affirming that it is a “widely available and cheap alternative to antibiotics”. The abstract also concludes that honey improves symptoms in comparison with “usual care”, which, left hitherto unspecified, and paired with the aforementioned focus on a comparison between honey and antibiotics, again augments the misleading introduction to the article. Fundamentally, none of the 14 the studies included within the systematic review compare the use of honey with the use of antibiotics. Focusing so strongly on comparing honey to antib...

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    Conflict of Interest:
    None declared.
  • Published on:
    Honey and in vitro antibacterial properties including Helicobacter pylori

    I read with interest the latest evidence for honey and treatment of coughs which was also reported widely in the national press (1). Honey has been shown in laboratory in vitro studies to inhibit bacterial growth including Helicobacter pylori linked with dyspepsia and gastritis (2, 3). Concentrations between 10-20% honey has been shown to be effective against both Gram negative and Gram positive bacteria (3). My late father Professor MNH Chowdhury, a clinical bacteriologist, researched this in the 1990s and advocated Manuka honey especially for its healing and antibacterIal properties. Interestingly, the in vitro findings showed some isolates were resistant to various antimicrobial agents but honey inhibited these organisms also (3). Secondary bacterial infections may respond to this simple remedy after primary viral coughs and colds and need further clinical study.
    References
    1. Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis. BMJ Evidence Based Med 2020, 18 Aug online; bmjebm-2020-111336.
    2. Rashed RS, Ayoola EA, Mofleh IA, Chowdhury MNH, Mahmood K, Faleh FZ. Helicobacter pylori and dyspepsia in an Arab population. Trop Geogr Med 1992; 44(4), 304-7.
    3. Ali AT, Chowdhury MNH, al Humayyad MS. Inhibitory effect of natural honey on Helicobacter pylori. Trop Gastroenterol 1991; 12(3), 139-43.

    Conflict of Interest:
    Reporting previous peer reviewed research done by family member 28-30 years ago.
  • Published on:
    Symptomatic relief or Cure?
    • Arvind Joshi, Physician( Medicine and Therapeutics), Founder Convener and President Our Own Discussion Group. Our Own Discussion Group, Mumbai and Ruchi Diagnostic Center and Ruchi Clinical Laboratory, Kharghar.

    It is risky to propose that agent offering symptomatic relief should replace microbial cure. Two are different aspects and different approaches.
    Besides honey may not be considered entirely safe. Many environmental Journals are raising voice against contamination of honey either by microbes or by antimicrobials.
    Clinicians must know if the Upper Respiratory Infection is going to be entirely selflimited and will not progress to Pneumonia, or lead to late Sequelae like Rheumatic Fever Rheumatic Heart Disease.
    If only symptomatic relief is to be achieved, one wonders if home made sugar syrup may work as well as honey will. Moreover homemade sugar syrup will not carry microbes or antimicrobials!
    Arvind Joshi MBBS MD FCGP FAMS FICP.

    Conflict of Interest:
    None declared.
  • Published on:
    Honey! Go for the Cure!
    • Arvind Joshi, Physician( Medicine and Therapeutics), Founder Convener and President: Our Own Discussion Group. Our Own Discussion Group, Ruchi Diagnostic Center and Ruchi Clinical Laboratory.

    The Editor
    Read with interest the article
    " Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis"
    Symptomatic relief and treatment of infections are entirely different treatment goals.
    A clinician must decide very clearly either on clinical grounds or with investigations, if the infection is going to be a selflimited one which will subside completely without any antimicrobial and also will not cause any late Sequelae. A very important example in this regards used to be Streptococcal throat infections which often would subside without proper antimicrobial treatment, only to cause Rheumatic Fever, Rheumatic Arthritis and Rheumatic Heart Disease later. Not necessarily upper respiratory tract infections, post Streptococcal Glomerulonephritis, post Rickettsial complications are some of the examples where not symptomatic relief, but prompt and adequuate treatment of infections with antimicrobials is crucial for preventing devastating Sequelae.
    It is often very difficult to to foresee which respiratory or for that matter any infection will be self limited and will not cause any serious Sequelae if no antimicrobials are used.
    That is the CATCH!
    Arvind Joshi;
    MBBS, MD; FCGP, FAMS;
    Founder Convener and President:
    Our Own Discussion Group,
    602-C, Megh Apartments,
    Ganesh Peth Lane, Dadar West;
    Mumbai PIN 400028;
    Consaltant...

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    Conflict of Interest:
    None declared.