Honey has been used since ancient times for the treatment of wounds. The discovery of antibiotics made its use less appealing, but the development of antibiotic resistance has again increased the interest in honey for its antibacterial properties. However, attention must be paid to the quality of the honey used for medical application. Honey may contain toxic compounds when plants in honey harvesting areas are treated with herbicides and pesticides or are polluted with industrial heavy metals, antibiotics, or exposed to environmental pollution. Moreover, bacterial contamination of honey with, for example, Clostridium endospores has long been disregarded. Honey directly obtained from the beekeeper or from the store may not therefore be suitable and it may even be dangerous for use or for wound healing, as there is no guarantee that it is safe, or it may not be effective because of inappropriate sterilization methods. Therefore, there is a need for a clear definition of ‘medical grade honey’ (MGH), to guarantee its safety and efficacy for therapeutic uses. Due to the current lack of strict guidelines to achieve standardized MGH formulations, this article poses clear standards and criteria, including those related to the collection, possible contamination, sterilization, production, storage, physicochemical, legal and safety issues to which MGH should adhere to distinguish itself from regular honey. We discuss current honey-based wound care products and whether they adhere to the standards of MGH. The presented guidelines should result in safe MGH formulations that are effective for wound healing.

Recurrent vulvovaginal candidiasis (RVVC) is predicted to increase to almost 158 million cases annually by 2030. Extensive self-diagnosis and easily accessible over-the-counter (OTC) fungistatic drugs contribute to antifungal-resistance, illustrating the need for novel therapies. Honey possesses multiple antimicrobial mechanisms, and there is no antimicrobial resistance towards honey reported. We evaluated the susceptibility of five clinical isolates of Candida albicans and a control strain to regular honey and a medical grade honey (MGH) gel formulation (L-Mesitran, containing 40% honey and vitamins C and E) using an adapted version of the EUCAST protocol at pH 5.2, 4.6, and 4.0. 40% regular honey did not kill or inhibit C. albicans. In contrast, the minimal inhibitory concentration (MIC) of L-Mesitran was 25%–50%, while fungicidal effects occurred at a 50% concentration (MBC) of the MGH formulation, except for one strain which was not killed at pH 4.0. Overall, pH had little effect on antimicrobial activity. MGH formulation L-Mesitran has antimicrobial activity against C. albicans over a relevant pH range. The vitamin supplements or other components of L-Mesitran may enhance the antifungal activity of the honey. This study supports performing clinical trials for conditions, such as RVVC, to find an alternative to available OTC fungistatic drugs.