Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis

Abuelgasim, Hibatullah
Albury, Charlotte
Lee, Joseph

¹Oxford University Medical School, University of Oxford, Oxford, UK
²Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Correspondence to Hibatullah Abuelgasim, Medical Sciences Divisional Offices, University of Oxford, Oxford, OX3 9DU, UK; e-mail: [email protected]

Accepted June 21, 2020; previously published online August 18, 2020

Twitter@AlburyCharlotte

Funding No external funding was recieved for this work. HA: medical student, University of Oxford. CA: NIHR SPCR trainee. JL: NIHR SPCR Career Progression Fellow.

Competing interests JL is a hobby beekeeper.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement We are unable to share primary data as these are published papers that we do not have permission to share. All references are provided, although subscriptions may be required for access.

BMJ Evidenced-Based Medicine 26(2):p 57-64, April 2021. | DOI: 10.1136/bmjebm-2020-111336

ABSTRACT

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, I²=0%), cough frequency (eight studies, standardised mean difference (SMD) −0.36, 95% CI −0.50 to −0.21, I²=0%) and cough severity (five studies, SMD −0.44, 95% CI −0.64 to −0.25, I²=20%). We combined two studies comparing honey with placebo for relieving combined symptoms (SMD −0.63, 95% CI −1.44 to 0.18, I²=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.

PROSPERO registration No

Study ID, CRD42017067582 on PROSPERO: International prospective register of systematic reviews (https://www.crd.york.ac.uk/prospero/).