Topical honey for diabetic foot ulcers.

摘要

A 79-year-old man with type 2 diabetes mellitus developed heel and forefoot ulcers, for which he received currently recommended therapy,1-5 including an off-loading orthotic, systemic antibiotics selected by infectious disease consultants, and topical therapies directed by a wound care expert. After 14 months of care costing Dollars 390,000--a cost that included 5 hospitalizations and 4 surgeries-the ulcers measured 8 x 5 cm and 3 x 3 cm. Deep tissue cultures grew methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Pseudomonas. During this time the patient lost 2 toes but refused below-the-knee amputation, despite being informed by 2 different surgical teams that without it he would likely die. This opinion was based on the patient's recurrent episodes of heel osteomyelitis and multiple medical complications, including acute renal failure from culture-specific antibiotics. The patient was eventually discharged to his home at his request, after consulting with his family and the hospital's ethics committee. He lost a third toe before consenting to a trial of topical honey.