Honey is a complex natural substance that may contain 600 components [3]. As a highly concentrated sugar product with low moisture content and low acidity, it is likely to prevent growth of vegetative microbial cells. The antimicrobial activity may also be in certain honeys based on an enzyme (glucose oxidase), which converts glucose to hydrogen peroxide and gluconic acid [4, 5]. The antimicrobial effects also include MRSA from both infected and colonised wounds [1, 6]. The generation of peroxide subdivided the honey in peroxide or non-peroxide honey types.

While the broad spectrum of antimicrobial activity is well known, the mechanism of the debriding action of honey is almost unknown. Honey has not directly been reported to have a proteolytic activity [7], and it can therefore be assumed that honey removes attached slough, necrotic tissue and eschar by facilitating autolytic debridement. This can be achieved through the high sugar content of honey resulting in an osmotic withdrawal of fluid (lymph) from the wound bed, which is replaced from the underlining circulation. Honey has, however, demonstrated a faster rate of debridement than using hydrogels. This suggests that honey may have a stimulatory action on proteases in the wound bed [7]. The osmotic-induced outflow of lymph may also lead to extra oxygenation and an improved supply of nutrients to the growing cells, resulting in an improved healing of the wounds. Differences in the degree of activation of proteolysis between different types of honey may account for the differences in speed of debridement reported.