Honey as topical prophylaxis against radiochemotherapy-induced mucositis in head and neck cancer

J Laryngol Otol. 2009 Feb;123(2):223-8. doi: 10.1017/S0022215108002478. Epub 2008 May 19.


Aim: To evaluate the efficacy of pure natural honey as prophylaxis against radiochemotherapy-induced mucositis, through clinical scoring of oral and oropharyngeal mucositis, and culturing of pathogenic oral and oropharyngeal microbes.

Patients and methods: The study was done in Assiut University Hospital, Egypt, between January 2005 and July 2006. Forty patients diagnosed with head and neck cancer were entered into the trial. Enrolled patients were randomised to either the treatment group, receiving concomitant chemotherapy and radiotherapy (with a significant area of directly visible oral and/or oropharyngeal mucosa included in the radiation fields) plus prior topical application of pure natural honey, or the control group, receiving concomitant chemotherapy and radiotherapy without honey. Patients were evaluated clinically every week to assess development of radiation mucositis. Aerobic cultures and candida colonisation assessment were undertaken, via oral and oropharyngeal swabs, prior to and at the completion of irradiation, and when infection was evident.

Results: In the treatment group, no patients developed grade four mucositis and only three patients (15 per cent) developed grade three mucositis. In the control group, 13 patients (65 per cent) developed grade three or four mucositis (p < 0.05). Candida colonisation was found in 15 per cent of the treatment group and 60 per cent of the control group, either during or after radiotherapy (p = 0.003). Positive cultures for aerobic pathogenic bacteria were observed in 15 per cent of the treatment group and 65 per cent of the control group, during or after radiotherapy (p = 0.007).

Conclusion: This study shows that prophylactic use of pure natural honey was effective in reducing mucositis resulting from radiochemotherapy in patients with head and neck cancer.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Anti-Infective Agents, Local / administration & dosage*
  • Combined Modality Therapy / adverse effects
  • Female
  • Head and Neck Neoplasms / drug therapy
  • Head and Neck Neoplasms / radiotherapy*
  • Honey*
  • Humans
  • Male
  • Middle Aged
  • Mouth Mucosa / radiation effects*
  • Mucositis / microbiology
  • Mucositis / therapy*
  • Radiation Injuries / microbiology
  • Radiation Injuries / therapy*
  • Treatment Outcome


  • Anti-Infective Agents, Local