Topical Honey in the Management of Pediatric Peritoneal Dialysis Exit Sites

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.