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Evidência científica para o uso do mel farmacêutico no tratamento de feridas crónicas
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Ao longo da história, o mel tem tido um papel importante na vida e na saúde das comunidades, tanto como alimento como agente terapêutico. Os seus componentes atuam de modo sinergístico, conferindo-lhe potencial na atividade contra diversos microrganismos.
Nas últimas décadas, o interesse pela sua capacidade terapêutica no tratamento de feridas reconquistou interesse por parte dos investigadores. A resistência aos antimicrobianos tem sido uma crescente preocupação, sendo que uma das possíveis soluções para este flagelo reside em alternativas terapêuticas como o mel.
O mel farmacêutico permite combater a infeção, acelerar a cicatrização, reduzir o uso de antibióticos e economizar recursos, melhorando a qualidade de vida dos pacientes. O mel demonstra, entre outras, propriedades antimicrobianas, imunomoduladoras, anti-inflamatórias, cicatrizantes e desbridantes. O mel de manuka é, por exemplo, um mel com atividade não devida a peróxido de hidrogénio, sendo um dos mais estudados e utilizados no tratamento de feridas.
A elevada osmolaridade, alta concentração de açúcar, baixa acidez (pH entre 3,2 e 4,5), reduzida atividade da água (inferior a 0,60), elevada viscosidade e presença de compostos fenólicos concorrem para a atividade antibacteriana do mel, a qual, em alguns méis, também é devida ao teor em peróxido de hidrogénio. A atividade antibacteriana decorre igualmente do stress oxidativo associado à formação e acumulação de radicais hidroxílicos que inibem o crescimento bacteriano (dependente da concentração).
O material de penso com ação terapêutica nas feridas crónicas, classificado como dispositivo médico, pode ser dividido em vários grupos, consoante as suas características: hidrocolóides, alginatos, espumas, hidrogeles, antimicrobianos (onde se inserem os apósitos de mel), entre outros.
O mel farmacêutico pode ter diversas origens entomológicas, botânicas e geográficas, devendo cumprir rigorosos critérios de qualidade, segurança e uniformização. As formulações comercializadas devem ser otimizadas de forma a apresentar uma boa relação de eficácia/segurança.
Existe evidência científica dos benefícios do mel no tratamento de feridas crónicas, nomeadamente úlceras de pé diabético, úlceras venosas crónicas, úlceras cirúrgicas e úlceras de pressão. Tais benefícios são, em muitos casos, comparáveis aos tratamentos convencionais, em equivalência e superioridade, espelhados nos resultados clínicos obtidos.
Para que o mel farmacêutico se possa afirmar como agente terapêutico de primeira linha, mais estudos precisam de ser realizados, especialmente no que toca à melhor caracterização físico-química dos vários méis disponíveis, clarificação de alvos terapêuticos e mecanismos de ação do mel, assim como melhor uniformização e otimização das formulações comercializadas.
Throughout history, honey has played an important role in the life and health of communities, both as food and as a therapeutic agent. Its components act synergistically, giving it potential in the activity against various microorganisms. In the last decades, the interest for its therapeutic capacity in wound treatment has regained interest from researchers. Resistance to antimicrobials has been a growing concern, and one of the possible solutions to this scourge lies in therapeutic alternatives such as honey. The pharmaceutical honey allows fighting the infection, accelerating healing, reducing the use of antibiotics and saving resources, improving the quality of life of patients. Honey demonstrates, among others, antimicrobial, immunomodulatory, anti-inflammatory, healing and debriding properties. Manuka honey is, for example, a honey with "non-peroxide activity", being one of the most studied and used in wound treatment. The high osmolarity, high sugar concentration, low acidity (pH between 3.2 and 4.5), reduced water activity (less than 0.60), high viscosity and presence of phenolic compounds contribute to the antibacterial activity of honey, which in some honeys is also due to the content of hydrogen peroxide. The antibacterial activity also results from the oxidative stress associated with the formation and accumulation of hydroxyl radicals that inhibit bacterial growth (concentration-dependent). Dressing materials with therapeutic action on chronic wounds, classified as a medical devices, can be divided into several groups, depending on its characteristics: hydrocolloids, alginates, foams, hydrogels, antimicrobials (where honey dressings are inserted), among others. Pharmaceutical honey can have several entomological, botanical and geographic origins, and must meet strict criteria of quality, safety and uniformity. The commercialized formulations must be optimized in order to present a good relation of efficacy/safety. There is scientific evidence of the benefits of honey in the treatment of chronic wounds, namely diabetic foot ulcers, chronic venous ulcers, surgical ulcers and pressure ulcers. Such benefits are, in many cases, comparable to conventional treatments, in equivalence and superiority, mirrored in the clinical results obtained. For pharmaceutical honey to assert itself as a first-line therapeutic agent, more studies need to be conducted, especially regarding the best physicochemical characterization of the various honeys available, clarification of therapeutic targets and mechanisms of action of honey, as well as better uniformization and optimization of marketed formulations.
Throughout history, honey has played an important role in the life and health of communities, both as food and as a therapeutic agent. Its components act synergistically, giving it potential in the activity against various microorganisms. In the last decades, the interest for its therapeutic capacity in wound treatment has regained interest from researchers. Resistance to antimicrobials has been a growing concern, and one of the possible solutions to this scourge lies in therapeutic alternatives such as honey. The pharmaceutical honey allows fighting the infection, accelerating healing, reducing the use of antibiotics and saving resources, improving the quality of life of patients. Honey demonstrates, among others, antimicrobial, immunomodulatory, anti-inflammatory, healing and debriding properties. Manuka honey is, for example, a honey with "non-peroxide activity", being one of the most studied and used in wound treatment. The high osmolarity, high sugar concentration, low acidity (pH between 3.2 and 4.5), reduced water activity (less than 0.60), high viscosity and presence of phenolic compounds contribute to the antibacterial activity of honey, which in some honeys is also due to the content of hydrogen peroxide. The antibacterial activity also results from the oxidative stress associated with the formation and accumulation of hydroxyl radicals that inhibit bacterial growth (concentration-dependent). Dressing materials with therapeutic action on chronic wounds, classified as a medical devices, can be divided into several groups, depending on its characteristics: hydrocolloids, alginates, foams, hydrogels, antimicrobials (where honey dressings are inserted), among others. Pharmaceutical honey can have several entomological, botanical and geographic origins, and must meet strict criteria of quality, safety and uniformity. The commercialized formulations must be optimized in order to present a good relation of efficacy/safety. There is scientific evidence of the benefits of honey in the treatment of chronic wounds, namely diabetic foot ulcers, chronic venous ulcers, surgical ulcers and pressure ulcers. Such benefits are, in many cases, comparable to conventional treatments, in equivalence and superiority, mirrored in the clinical results obtained. For pharmaceutical honey to assert itself as a first-line therapeutic agent, more studies need to be conducted, especially regarding the best physicochemical characterization of the various honeys available, clarification of therapeutic targets and mechanisms of action of honey, as well as better uniformization and optimization of marketed formulations.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2020.
Palavras-chave
Mel farmacêutico Feridas crónicas MRSA Apósito Dispositivo médico Mestrado integrado - 2020