Use of Honey in the Management of Chemotherapy-Associated Oral Mucositis in Paediatric Patients

Figures & data

Table 1 Detailed Exclusion Criteria for the Present Study

Exclusion Criteria	Description
Participants	Age year ≤1
	No capacity for oral feeding
	Diagnosed with diabetes tested HIV^+
	Allergic to honey (information supplied from families)
Intervention	Manuka honey
Studies	Case–control studies
	Cohort studies
	Cross-sectional studies

Abbreviation: HIV⁺, human immunodeficiency virus positive.

Table 2 Detailed Characteristics of Participants Included in the Present Studies (Experimental and Control Groups)

Study Design	Participants	Age	Intervention	Comparison	OM Grade	Country	Reference
Randomised controlled pilot study	n=33 (F) n=57 (M)	≥2 to ≤18Y	Nature honey/HOPE (routine oral care)	Benzocaine 7.5% gel (routine oral care)	II and III	Egypt	Abdulrhman et al, 2012^Citation27
Quasi-experimental study with a control group	n=38 (F) n=38 (M)	≥6 to ≤17Y	Natural and standardized flower honey (routine and standard mouth care)	Routine mouth care	No OM/all grades	Turkey	Bulut and Tüfekci, 2016^Citation26
RCT	n=16 (F) n=24 (M)	≥5 to ≤19Y	Honey and tulsi ice chips	Plain ice cubes	No OM	India	Mishra and Nayak, 2017^Citation29
Open-label RCT	n=19 (F) n=21 (M)	≥1Y	Local Saudi commercial honey (routine oral hygiene)	Routine oral hygiene (Lidocaine, Mycostatin, Daktarin mouth gel, and mouthwash)	III and IV	Saudi Arabia	Al Jaouni et al, 2017^Citation28
Observational blind design	n=100 (N/D)	N/D	Commercially available marketed honey product (the routine practice of analgesic and antiseptic gel)	The routine practice of analgesic and antiseptic gel application	I and II	India	Singh et al, 2019^Citation12

Abbreviations: RCT, randomised controlled trial; n, the number of participants; N/D, not detected; F, female; M, male; OM, oral mucositis.

Table 3 Characteristics of Recovery Time and the Severity of OM

OM Grades	Recovery Time (Days)		Measure of Difference	OM Status		Measure of Difference	Study Reference
	EG (Mean±SD)	CG (Mean±SD)		EG (Mean±SD)	CG (Mean±SD)
II	3.6±0.8	4.6±0.9	P=0.0017				Abdulrahman et al, 2012^Citation27
III	5.4±1.1	8.6±1.0	P=0.0001
II and III	4.25±1.25	6.20±2.47	P=0.0005
Any grades	4.869±4.341/82.6% full recovery (before OM occurred)	19.282±1.805 /5.1% full recovery	P=0.000	0.43±0.58 (before OM occurred)	1.79±1.08	P=0.000 (Day 4)	Bulut and Tüfekci, 2016^Citation26
				3.07±0.47 (after OM occurred)		P=0.000 (Day 4)
	14.857±2.905/92.9% full recovery (after OM occurred)		P=0.000	0.17±0.38 (before OM occurred)	1.76±1.03	P=0.000 (Day 21)
				0.14±0.36 (after OM occurred)		P=0.000 (Day 21)
III and V	7±3	13±5	P<0.001	20% (III and V)	55% (III and V)	P=0.02	Al Jaouni et al, 2017^Citation28
	40% mild–moderate (day 5)	65% mild–moderate 25% severe (day 5)		0.4±0.50	1.75±0.96	P=0.001 (Day 5)	Mishra and Nayak, 2017^Citation29
	15% mild–moderate (day 15)	80% mild– moderate (day 15)		0.15±0.36	1.1±0.71	P =0.001 (Day 5)
I and II	4(4–6) (IQR) 4–12 (range)	6(6–8) (IQR) 2–8 (range)	P<0.01				Singh et al, 2019^Citation12
	Day 9 (cured)	Day 13 (cured)

Notes: The bold numbers indicate statistically significant (P<0.05); grey blank indicates.

Abbreviations: EG, experimental group; CG, control group.

Figure 1 The study selection process is presented as PRISMA flow diagram.

Notes: Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).³³

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