title: Topical Honey in the Management of Pediatric Peritoneal Dialysis Exit Sites.
abstract: International guidelines in peritoneal dialysis (PD) advocate for regular application of topical mupirocin in chronic PD exit-site care. A strong evidence base links this treatment to reduced rates of exit-site infections and peritonitis. However, emerging reports of increasing mupirocin resistance and gram-negative infections are threatening the long-term viability of topical antibiotic ointments as a prophylactic treatment. Medical grade honey has multiple proven antibacterial and wound healing properties. High-quality randomized controlled trial evidence (the HONEYPOT trial), however, does not support the use of topical medical-grade honey over antibiotic ointments for the prevention of exit-site infection and peritonitis in adults. Pediatric representation in these studies is low, and these findings may not extrapolate to the pediatric context, which has a higher incidence of PD-related infection and a lower prevalence of diabetes.We present a series of 8 pediatric patients treated with topical Medihoney (Comvita, Paengaroa, New Zealand) in the context of poor exit-site condition, persistent infection, and recurrent granuloma where the addition of honey was felt to produce remarkable improvement in exit-site status.Medihoney is the first-line prophylactic exit-site ointment in PD exit sites at our institution and has been implicated in the salvage of peritoneal access in some patients. No exclusively pediatric studies have been performed; however, existing literature suggests a beneficial effect in promoting healing of infected wounds with a lower risk of developing antimicrobial resistance.
authors.affiliation: Department of Nephrology, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Forbes
authors.affiliation: Department of Nephrology, The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Loren
authors.initials: L
authors.lastname: Shaw
authors.affiliation: Department of Nephrology, The Royal Children's Hospital, Parkville, Victoria, Australia Catherine.Quinlan@rch.org.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Quinlan
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D002408:Catheters, Indwelling / Q000009:adverse effects* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006722:Honey; D006801:Humans; D007223:Infant; D008297:Male; D009520:New Zealand; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control*; D017592:Skin Care; D016896:Treatment Outcome
keywords: Honey; exit-site infection; peritoneal dialysis; peritonitis