Novel topical combo-therapeutic formulation integrating honey, neomycin and bacitracin for diabetic wound management

Abstract

This study evaluated the healing effects of honey as a topical therapy for diabetic ulcers singly and in combination with bacitracin and neomycin (Cicatrin®), formulated as ointments in experimental rats. Antimicrobial evaluation of the test agents against Vancomycin and Oxacillin resistant Staphylococcus aureus (VORSA) and Pseudomonas aeruginosa was done by the cup plate agar-diffusion technique using the Checkerboard method. Subsequently, the optimized combination was formulated into an ointment and administered as single therapy and in combination to hyperglycemic rats made diabetic by subcutaneous injection of alloxan (130 mg/kg) and inflicted with wounds. Administration was done daily on wounds for 21 days while infected wounds had the pus from them evaluated for presence of VORSA and Pseudomonas aeruginosa. The triple combo-therapeutics formulation had improved anti-bacterial activity, in comparison with the individual formulations, with the ratio (1:9) of Cicatrin®: Honey respectively giving the best activity against VORSA. Also, the triple combo-therapeutics exhibited positive wound contraction and size reduction. Furthermore, clinical signs of infection were absent at the end of the follow-up period in the rats administered the combo-therapeutic agents while other groups of rats administered the bland ointment, and the individual agents were infected with either Pseudomonas aeruginosa or VORSA. In addition, the triple combo-therapeutics formulation exhibited good physicochemical stability throughout the treatment duration and beyond (28 days), with insignificant (p > 0.05) changes in pH and spreadability. The triple combination therapeutics formulation showed superior effect to the singly administered agents (honey and Cicatrin®) in the management of diabetic wounds