Journal
BMJ EVIDENCE-BASED MEDICINE
Volume 26, Issue 2, Pages 57-64Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmjebm-2020-111336
Keywords
general practice; public health
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Honey is more effective than usual care for improving symptoms of upper respiratory tract infections. It is a widely available and cost-effective alternative to antibiotics for URTIs, but further high-quality trials are needed to confirm its benefits in reducing antimicrobial resistance.
Background Antibiotic over prescription for upper respiratory tract infections (URTIs) in primary care exacerbates antimicrobial resistance. There is a need for effective alternatives to antibiotic prescribing. Honey is a lay remedy for URTIs, and has an emerging evidence base for its use. Honey has antimicrobial properties, and guidelines recommended honey for acute cough in children. Objectives To evaluate the effectiveness of honey for symptomatic relief in URTIs. Methods A systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, AMED, Cab abstracts, Cochrane Library, LILACS, and CINAHL with a combination of keywords and MeSH terms. Results We identified 1345 unique records, and 14 studies were included. Overall risk of bias was moderate. Compared with usual care, honey improved combined symptom score (three studies, mean difference -3.96, 95% CI -5.42 to -2.51, I-2=0%), cough frequency (eight studies, standardised mean difference (SMD) -0.36, 95% CI -0.50 to -0.21, I-2=0%) and cough severity (five studies, SMD -0.44, 95% CI -0.64 to -0.25, I-2=20%). We combined two studies comparing honey with placebo for relieving combined symptoms (SMD -0.63, 95% CI -1.44 to 0.18, I-2=91%). Conclusions Honey was superior to usual care for the improvement of symptoms of upper respiratory tract infections. It provides a widely available and cheap alternative to antibiotics. Honey could help efforts to slow the spread of antimicrobial resistance, but further high quality, placebo controlled trials are needed.
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