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

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Johnson, D. W., Badve, S. V., Pascoe, E. M., Beller, E., Cass, A., Clark, C.,de Zoysa, J., Isbel, N., McTaggart, S., Morrish, A., Playford, G., Scaria, A., Snelling, P., Vergara, L., & Hawley, C. M. (2014). Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): A randomised trial. The Lancet Infectious Diseases, 14(1), 23-30.

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© Copyright, The Lancet, 2013

2013 HERDC Submission. FoR code: 111717: 110399




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. Funding: Baxter Healthcare, Queensland Government, Comvita, and Gambro.

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