THE ORIGINAL WOUND CARE SOLUTION

Transcription

1 THE ORIGINAL WOUND CARE SOLUTION

2 MEDIHONEY WOUND CARE FIRST CHOICE IN INFECTION CONTROL. Powerful antibacterial barrier effective against more than 200 clinical isolates EXCEPTIONAL ANTIBACTERIAL ACTION AGAINST GRAM -VE AND GRAM +VE BACTERIA Over 200 clinical isolates screened including: Staphylococcus aureus (MRSA & MSSA) Pseudomonas aeruginosa Acinetobacter calcoaceticus Klebsiella pneumoniae The high osmotic potential of Medihoney dressings cleans the wound Waxes in Antibacterial Wound Gel migrate onto wound bed to form a protective layer Antibacterial Wound Gel provides a protective layer which allows for easy dressing removal MIC OF 127 DRUG-RESISTANT CLINICAL ISOLATES ( ) Narelle George, Qld Health Pathology and Scientific Services, Royal Brisbane Hospital Bacteria MRSA / nm* MRSA ESBL VRE Acinetobacter Pseudomonas aeruginosa Minimum Inhibitory Concentration (MIC). * nm: non-multiresistant Concentration of Medihoney (%) Antibacterial Honey 0% 2% 4% 6% 8% 10% 12% 14% 16%

3 MEDIHONEY CASE REPORTS CASE REPORT 1: REDUCING PAIN AND BLEEDING ASSOCIATED WITH DRESSING CHANGES BACKGROUND 78 year old lady with history of lymphoedema, renal failure, epilepsy and peripheral vascular disease. Ulcers had been managed with a number of treatments but ulcer on right leg remained and was very painful. Wound swabs demonstrated the wound infiltrated with Streptococcus pyogenes and Staphylococcus aureus BEFORE TREATMENT AFTER 2 DAYS OUTCOMES Offensive odour removed in hrs. Size of the wound reduced with healing from the edges very noticeable. Pain subsided allowing reduction in analgesia. Dressings proved easier to apply and remove with less distress to the patient. Bleeding was reduced. Patient happier with significantly less pain. Direct material cost savings of over 20%. AFTER 4 WEEKS AFTER 6 MONTHS CASE REPORT 2: POSITIVE EFFECT ON MRSA INFECTIONS IN STERNAL WOUND BACKGROUND 69-year-old gentleman. Underwent Coronary Artery Bypass (4) Grafts. Prophylactic antibiotics were administered as per standard protocol. Stable post-operatively but a sternal wound discharge was noted on day 7. Wound culture confirmed the presence of MRSA. MRSA INFECTION 2 months after sternum opened MRSA infection MRSA CLEARED Day 8: Following application of Medihoney Antibacterial Honey MRSA cleared Day 18: Sternal wound closure Day 8 debridement of the wound, the sternum was left open and a negative pressure vacuum device (VAC) was applied. After 2 months of continuous treatment with IV antibiotics and VAC, sternal wound remained MRSA infected with a heavy exudate. OUTCOMES Within the first week, after application of Medihoney Antibacterial Honey with VAC, wound clear of infection. 18 days after application of Medihoney Antibacterial Honey with VAC, patient returned to the operating theatre for closure of the sternal wound. Medihoney Antibacterial Honey demonstrated a positive effect (-ve wound swabs) when used in a heavily colonised MRSA wound recalcitrant to IV antibiotics and standard wound treatments.

4 CLINICAL RESEARCH OVER THE LAST SIX YEARS, MEDIHONEY PTY LTD HAS LED THE WORLD IN CLINICAL IN VIVO RESEARCH ON MEDICAL HONEYS. MEDIHONEY PTY LTD ACTIVELY SUPPORTS AND SPONSORS IN VIVO AND IN VITRO STUDIES BY LEADING INSTITUTIONS AROUND THE WORLD. PUBLISHED CLINICAL TRIALS 1. A Randomized, Controlled Trial of Topical Exit Site Application of Honey (Medihoney ) Versus Mupirocin for the Prevention of Catheter- Associated Infections in Haemodialysis Patients Prof David Johnson et al, Princess Alexandra Hospital, Brisbane, Australia Journal of the American Society of Nephrology (5): Prospective, open-label, randomised, controlled trial using Medihoney Antibacterial Medical Honey. HYPOTHESIS Medihoney Antibacterial Honey applied topically to the exit sites of haemodialysis catheters will be more effective than topical Mupirocin application in preventing catheter-associated infections. Avoid the problems of anti-microbial resistance seen with mupirocin chemoprophylaxis. RESULTS A total of 101 patients were enrolled, and none were lost to follow up. The incidence of catheter-associated bacteremias in the Medihoney -treated (n=51) and Mupirocin-treated (n=50) were comparable. During the study period 2% of staphylococcal isolates within the hospital were mupirocin resistant. Medihoney Antibacterial Honey and Mupirocin were well tolerated in both groups with no systemic side effects. PUBLISHED CLINICAL TRIALS 2. Patient acceptability and tolerance of Medihoney in the management of non-healing leg ulcers Cheryl Dunford, Salisbury Health Care, UK & Dr. Ralph Hanano, Hartmann. Journal of Wound Care (5): A prospective, descriptive, non-randomised feasibility study involving 4 UK centres to determine whether Medihoney Antibacterial Honey is an acceptable treatment for patients with leg ulcers in terms of pain relief, odour control and overall patient satisfaction. 40 patients with ulcers resistant to twelve weeks of compression were recruited. Medihoney Antibacterial Honey dressings were applied instead of their previous dressings for a 12-week period. All other aspects of care remained unchanged. RESULTS Ulcer pain and size decreased significantly. Odorous wounds were deodorised promptly. Positive impact on patient satisfaction with the Medihoney Antibacterial Honey treatment regime. CONCLUSIONS The results supported the previously reported positive effects of honey and revealed a high patient acceptability for Medihoney Antibacterial Honey treatment. CONCLUSIONS The application of Medihoney Antibacterial Medical Honey to exit sites of tunneled, cuffed haemodialysis catheters was safe, inexpensive and effective and resulted in a comparable rate of catheter-associated infections to that obtained with 2% Mupirocin. The effectiveness of Medihoney Antibacterial Medical Honey against antibiotic-resistant microorganisms and its low likelihood of selecting for further resistant strains suggest that Medihoney Antibacterial Medical Honey may represent a satisfactory, alternative means of preventing haemodialysis catheter infections.

5 CLINICAL RESEARCH PUBLISHED CASE SERIES 1. Wound care with antibacterial honey (Medihoney ) in pediatric hematology oncology. Simon A, Sofka K, Wiszniewsky G, Blaser G, Bode U, Fleischhack G., Department of Pediatric Hematology and Oncology, Children's Hospital, University of Bonn, Germany Supportive Care in Cancer (1): 91-7 Medihoney dressings have now been used for 3 years in wound care at the Department of Pediatric Oncology, Children's Hospital, University of Bonn. This paper presents clinical data from 16 wound care situations in 14 pediatric oncology patients. Most wounds that were treated with Medihoney dressings were dehiscent or infected surgical wounds, drainage sites including MRSA infections as well as secondarily healing deep wounds. Outcomes were sterile wound healing despite immunosuppression. Medihoney dressings were simple, convenient and non-adherent and required minimal cleaning of the wound. This observational study revealed a high acceptability of the Medihoney dressings by both patient and family, having a positive impact on patient and parent satisfaction. CLINICAL TRIALS IN PROGRESS 1. An evaluation of the effectiveness of Antibacterial Wound Gel in the management of chronic ulcers compared to Silvazine, the standard treatment (silver sulphadiazine/ chlorhexidine) Di Smith, Royal Brisbane Hospital, Australia Prospective, randomised controlled study. 65 patients in each arm of the study, 130 patients. PUBLISHED CASE SERIES 2. The Use of Leptospermum Honey (Medihoney ) in Wound Management Randomised clinical trial on 200 patients wounds healing by secondary intention. Val Robson, University Hospital Aintree, UK Prospective, randomised, controlled trial. OBJECTIVES Compare healing rates with Medihoney Antibacterial Honey and conventional wound dressings over 24 week period. Effect Medihoney Antibacterial Honey has on infected or colonised wounds by consistent wound swabbing. PRIMARY OUTCOME MEASURES Number of patients with significant improvement (reduction in size and depth of the wound). Number of patients with complete healing in 24 weeks. 3. An Evaluation of the Use of Medihoney Antibacterial Honey in the Management of Malodorous Wounds Toni Bradley, Palliative Care Service, Prince Charles Hospital, Australia Prospective, randomised, controlled trial on malodorous wounds. 20 patients Medihoney Antibacterial Honey, 20 patients standard dressing. OBJECTIVES To evaluate whether Medihoney Antibacterial Honey is effective in reducing malodour and controlling exudate over a 7 day treatment period. Quality of life improvement. PRIMARY OUTCOME Demonstrate that Medihoney Antibacterial Wound Gel is as effective as Silvazine in reducing the bacterial load present in chronic ulcers. SECONDARY OUTCOMES Improvement in clinical parameters of wound. Improvement in the histopathological and immunological parameters.

6 CLINICAL RESEARCH CLINICAL TRIALS IN PROGRESS CONTINUED 4. Comparative trial on prevention of infection in paediatric burns Prof Heinz Rode, Red Cross Children's Hospital Cape Town, South Africa Prospective, controlled, randomised trial. Standard treatment of SSD (Silver sulphadiazine) vs Medihoney Antibacterial Wound Gel. INCLUSIONS Superficial and partial thickness paediatric burns, less than 72 hours old. Less than 40% Total Body Surface Area. OBJECTIVES Prevention of infection. Time to complete healing. CLINICAL TRIALS COMPLETED 1. The effects of Medihoney Ophthalmic Honey on the ocular surface in dry eye syndrome and eyelid disease and related ocular surface disorders Dr Lee M Lenton, Dr Julie Albietz Ophthalmology Specialist Centre, Brisbane, Australia Single site, prospective, pilot study, non-masked, non-randomised. 80 patients non-responsive or not well controlled with conventional treatments: Non-autoimmune tear deficient dry eye; Sjogren s syndrome (autoimmune dry eye); Chronic eyelid disease. RESULTS The total colony-forming units (CFU) isolated from each of the dry eye groups prior to Medihoney Ophthalmic Honey use were significantly greater than the total CFU control group. Medihoney Ophthalmic Honey use significantly reduced total CFU in the lids and the conjunctiva of dry eye subjects at month 1 and month 3 compared to base line. At month 3 there were reductions in total CFU for all dry eye groups such that the CFUs were not significantly different to those of the control group. CONCLUSIONS Medihoney Ophthalmic Honey helps reduce the signs and symptoms associated with chronic ocular surface damage. Publication: Albietz JM & Lenton LM Effect of Antibacterial Honey on the ocular flora in tear deficiency and meibomian gland disease. Cornea; 25(9):

7 ANTIBACTERIAL WOUND GEL ONE PRODUCT, THREE ACTIONS. WOUND PROTECTION WOUND CLEANING WOUND HEALING MEDIHONEY ANTIBACTERIAL WOUND GEL IS A TOPICAL PREPARATION FOR CHRONIC AND ACUTE WOUND CARE. It has been specially formulated combining 80% Medihoney Antibacterial Honey with natural waxes and oils to provide a high viscosity gel that is easy to apply with good wash off characteristics when dressings are changed. Medihoney Antibacterial Wound Gel is proven to be clinically effective for: Inhibiting bacteria at the wound bed (effective against more than 200 clinical isolates); Fast, effective autolytic debridement on sloughy and necrotic tissue in an antibacterial environment; Rapidly removing malodour; Providing a moist wound healing environment thus reducing trauma and pain at dressing change. INDICATIONS: Surgical wounds Burns Pressure sores Acute & Chronic wounds Leg / foot ulcers Donor and recipient graft sites SUPERIOR WOUND BED PREPARATION: The high osmotic potential created by Medihoney Antibacterial Wound Gel causes a mass flow of bacteria, endotoxins and necrotic material away from the wound bed. This material is then contained in an antibacterial matrix for easy removal at dressing change. MIC OF 127 DRUG-RESISTANT CLINICAL ISOLATES ( ) Narelle George, Qld Health Pathology and Scientific Services, Royal Brisbane Hospital Bacteria MRSA / nm* MRSA ESBL VRE Acinetobacter Pseudomonas aeruginosa Minimum Inhibitory Concentration (MIC). * nm: non-multiresistant Concentration of Medihoney (%) 0% 2% 4% 6% 8% 10% 12% 14% 16% Antibacterial Honey Clinical and In Vitro research has shown that Medihoney Antibacterial Honey at low concentrations is effective against a broad spectrum of bacteria, including antibiotic-resistant strains.

8 THE ORIGINAL WOUND CARE SOLUTION DIRECTIONS FOR USE: Protect wound edges with a barrier cream. Medihoney Antibacterial Wound Gel can be directly applied to the wound bed. Ensure that Medihoney Antibacterial Wound Gel is in full contact with the wound bed (approximately 3mm thickness). A non-adherent gauze dressing should be applied to cover Medihoney Antibacterial Wound Gel. The secondary dressing should be sufficiently absorbent to accommodate the volume of wound exudate. Medihoney Antibacterial Wound Gel can be left on the wound for up to 7 days dependant on the exudate levels. ORDERING INFORMATION: PRODUCT NAME SIZE SHIPPER QTY Medihoney Antibacterial 10G 25 units per box Wound Gel single use tube 20 units per box Medihoney Antibacterial 20G 25 units per box Wound Gel single use tube 20 units per box Medihoney Antibacterial 50G Product Wound Gel re-sealable tube available soon References: 1. Sofka K et al Antibakterieller Honig (Medihoney ) zur Wundpflege - Wundantisepsis bei pädiatrischen Patienten in der Hämatologie-Onkologie? [Antibacterial Honey (Medihoney ) for Woundcare - an antiseptic option for wound care in paediatric oncology?]; Krankenhaus-Hygiene und Infektionsverhütung; 26(5): Simon A et al Wound care with antibacterial honey (Medihoney ) in pediatric hematology oncology. Supportive Care in Cancer; 14(1): Dunford CE & Hanano R Acceptability to patients of a honey dressing for non-healing venous ulcers. J Wound Care; 13(5): George NM Honey antimicrobial agent au naturel. Paper presented at the Australian Infection Control Association Third Biennial Conference, Hobart, June 5. Blair S Honey and Drug Resistant Pathogens. Paper presented at Joint Scientific Meeting of the Australian Society for Microbiology, Cairns, July 6. Lusby PE, Coombes AL, Wilkinson JM Bactericidal activity of different honeys against pathogenic bacteria. Arch Med Research; 36: Wilkinson JM, Cavanagh HMA Antibacterial activity of 13 honeys against Escherichia coli and Pseudomonas aeruginosa. J Med Food; 8(1): Irish J et al Honey has an antifungal effect against Candida species. Med Mycol; 44(3): HEAD OFFICE Comvita New Zealand Ltd Wilson Road South Paengaroa Bay of Plenty 3189 New Zealand NZ Toll Free Facsimile +64 (0) AUSTRALIA Medihoney Pty Ltd BTP Technology & Conference Centre Cnr Miles Platting Rd and Logan Rd Eight Mile Plains QLD 4113 Australia AUST Toll free: Facsimile: +61 (0) EC REP Medihoney (Europe) Ltd The Nova Building Herschel Street, Slough Berkshire SL1 1XS UK UK Toll free: Int Tel: +44 (0) Facsimile: +44 (0) Germany Telephone +49 (0) Facsimile +49 (0)

9 ANTIBACTERIAL MEDICAL HONEY ONE PRODUCT, THREE ACTIONS. WOUND PROTECTION WOUND CLEANING WOUND HEALING MEDIHONEY ANTIBACTERIAL MEDICAL HONEY IS A TOPICAL PREPARATION FOR CHRONIC AND ACUTE WOUND CARE. Medihoney Antibacterial Medical Honey contains 100% Medihoney Antibacterial Honey and is proven to be clinically effective for: Inhibiting bacteria at the wound bed (effective against more than 200 clinical isolates); Fast, effective autolytic debridement on sloughy and necrotic tissue in an antibacterial environment; Rapidly removing malodour; Providing a moist wound healing environment thus reducing trauma and pain at dressing change. INDICATIONS: Deep wounds Necrotic wounds Surgical wounds Sinus wounds Infected wounds Malodorous wounds SUPERIOR WOUND BED PREPARATION: The high osmotic potential created by Medihoney Antibacterial Medical Honey causes a mass flow of bacteria, endotoxins and necrotic material away from the wound bed. This material is then contained in an antibacterial matrix for easy removal at dressing change. MIC OF 127 DRUG-RESISTANT CLINICAL ISOLATES ( ) Narelle George, Qld Health Pathology and Scientific Services, Royal Brisbane Hospital Bacteria MRSA / nm* MRSA ESBL VRE Acinetobacter Pseudomonas aeruginosa Minimum Inhibitory Concentration (MIC). * nm: non-multiresistant Concentration of Medihoney (%) 0% 2% 4% 6% 8% 10% 12% 14% 16% Antibacterial Honey Clinical and In Vitro research has shown that Medihoney Antibacterial Honey at low concentrations is effective against a broad spectrum of bacteria, including antibiotic-resistant strains.

10 THE ORIGINAL WOUND CARE SOLUTION DIRECTIONS FOR USE: Protect wound edges with a barrier cream. Medihoney Antibacterial Medical Honey can be directly applied to the wound bed. A suitable ribbon/cavity dressing may be saturated with Medihoney Antibacterial Medical Honey for use in deep wounds. Ensure that Medihoney Antibacterial Medical Honey is in full contact with the wound bed. (Approximately 3mm thickness). The secondary dressing should be sufficiently absorbent to accommodate the volume of wound exudate. Medihoney Antibacterial Medical Honey can be left on the wound for up to 7 days dependant on the exudate levels. ORDERING INFORMATION: PRODUCT NAME SIZE SHIPPER QTY Medihoney Antibacterial 20G 25 units per box Medical Honey single use tube 20 units per box Medihoney Antibacterial 50G Product Medical Honey re-sealable tube available soon References: 1. Sofka K et al Antibakterieller Honig (Medihoney ) zur Wundpflege - Wundantisepsis bei pädiatrischen Patienten in der Hämatologie-Onkologie? [Antibacterial Honey (Medihoney ) for Woundcare - an antiseptic option for wound care in paediatric oncology?]; Krankenhaus-Hygiene und Infektionsverhütung; 26(5): Simon A et al Wound care with antibacterial honey (Medihoney ) in pediatric hematology oncology. Supportive Care in Cancer; 14(1): Dunford CE & Hanano R Acceptability to patients of a honey dressing for non-healing venous ulcers. J Wound Care; 13(5): George NM Honey antimicrobial agent au naturel. Paper presented at the Australian Infection Control Association Third Biennial Conference, Hobart, June 5. Blair S Honey and Drug Resistant Pathogens. Paper presented at Joint Scientific Meeting of the Australian Society for Microbiology, Cairns, July 6. Lusby PE, Coombes AL, Wilkinson JM Bactericidal activity of different honeys against pathogenic bacteria. Arch Med Research; 36: Wilkinson JM, Cavanagh HMA Antibacterial activity of 13 honeys against Escherichia coli and Pseudomonas aeruginosa. J Med Food; 8(1): Irish J et al Honey has an antifungal effect against Candida species. Med Mycol; 44(3): HEAD OFFICE Comvita New Zealand Ltd Wilson Road South Paengaroa Bay of Plenty 3189 New Zealand NZ Toll Free Facsimile +64 (0) AUSTRALIA Medihoney Pty Ltd BTP Technology & Conference Centre Cnr Miles Platting Rd and Logan Rd Eight Mile Plains QLD 4113 Australia AUST Toll free: Facsimile: +61 (0) EC REP Medihoney (Europe) Ltd The Nova Building Herschel Street, Slough Berkshire SL1 1XS UK UK Toll free: Int Tel: +44 (0) Facsimile: +44 (0) Germany Telephone +49 (0) Facsimile +49 (0)

11 BARRIER CREAM Medihoney Barrier Cream helps maintain the skin s barrier properties and maintain skin moisture and ph. Suitable for wet areas* Helps maintain ph of the skin Contains 30% Medihoney Antibacterial Honey *Medihoney Barrier Cream can be applied to intact and at-risk skin to provide protection from body fluids and moisture. It can be applied around wounds and under skin folds, wound dressings and incontinence pads where a protective barrier will help prevent skin breakdown. INDICATIONS FOR USE Protects at-risk skin from breakdown associated with incontinence and can be used under incontinence pads Can be used around wound edges to protect the skin from irritation or breakdown caused by wound exudate Helps protect the skin from damage caused by friction or shear Helps prevent maceration Helps prevent excoriation Helps maintain the skin ph Helps prevent damage to skin caused by frequent hand washing SPECIALLY FORMULATED Medihoney Barrier Cream is specially formulated with a range of natural ingredients and NO Added colour or fragrance NO Lanolin NO Parabens NO Steroids NO Mineral Oils DIRECTIONS FOR USE Apply to clean, dry skin three times a day or as required. Reapply after bathing or at each dressing change. Suitable for use on children. PRECAUTIONS When using for the first time, patch test on a small area of skin. If irritation occurs discontinue use. ORDERING INFORMATION PRODUCT NAME SIZE SHIPPER QTY Medihoney 50g resealable 24 units Barrier Cream tube per box

12 FIRST CHOICE IN SKIN AND WOUND CARE THE SKIN Normal skin has a naturally acidic protective mantle. The acid mantle helps to hydrate the skin by protecting it from drying and from harmful bacteria. Skin ailments such as eczema and dermatitis are linked to a disrupted acid mantle with subsequent colonisation by bacteria such as Staphylococcus aureus. The use of Medihoney Barrier Cream helps maintain the skin's protective ph. In vitro studies have shown Staphylococcus aureus to be one of the most sensitive bacteria to Medihoney s Antibacterial Honey. Medihoney Barrier Cream contains 30% Medihoney Antibacterial Honey which is proven to be effective against a range of microorganisms. MEDIHONEY ANTIBACTERIAL HONEY Medihoney wound care and skin care products contain medical grade Antibacterial Honey. Advanced biomedical research by Medihoney has identified specific plants that produce honey with exceptional antibacterial activity. The antibacterial activity of honey differs according to the plant species and may vary enormously within any one species. Medihoney Antibacterial Honey is a standardised antibacterial honey, predominantly Leptospermum sp. selected for its broad range of antibacterial actions. In 2007, the journal Wounds featured an article that evaluated the in vitro activity of Medihoney Antibacterial Honey against a challenge set of 127 clinical isolates with multiple antibiotic resistance. The study showed that the Medihoney Antibacterial Honey was effective at inhibiting these bacteria irrespective of their level of antibiotic resistance. Particularly effective against Staphylococcus aureus and MRSA down to a 4% dilution 1. MIC OF 127 DRUG-RESISTANT CLINICAL ISOLATES ( ) Narelle George, Qld Health Pathology and Scientific Services, Royal Brisbane Hospital * nm: non-multiresistant Bacteria Minimum Inhibitory Concentration (MIC). MRSA / nm* MRSA ESBL VRE Acinetobacter Pseudomonas aeruginosa Concentration of Medihoney (%) Antibacterial Honey 0% 2% 4% 6% 8% 10% 12% 14% 16% References: 1. George NM & Cutting K F Antibacterial Honey (Medihoney ): in-vitro Activity Against Clinical Isolates of MRSA, VRE, and Other Multiresistant Gram-negative Organisms Including Pseudomonas aeroginosa. J Wounds; 19(9): Taskapan MO & Kumar P Role of staphylococcal superantigens in atopic dermatitis: from colonisation to inflammation. Annals of Allergy, Asthma, & Immunology; 84(1): 3-10 HEAD OFFICE Comvita New Zealand Ltd Wilson Road South Paengaroa Bay of Plenty 3189 New Zealand NZ Toll Free Facsimile +64 (0) AUSTRALIA Medihoney Pty Ltd BTP Technology & Conference Centre Cnr Miles Platting Rd and Logan Rd Eight Mile Plains QLD 4113 Australia AUST Toll free: Facsimile: +61 (0) EC REP Medihoney (Europe) Ltd The Nova Building Herschel Street, Slough Berkshire SL1 1XS UK UK Toll free: Int Tel: +44 (0) Facsimile: +44 (0) Germany Telephone +49 (0) Facsimile +49 (0)

13 DERMA CREAM Medihoney Derma Cream helps to protect vulnerable skin and moisturise dry skin conditions. Suitable for dry areas* Helps maintain ph of the skin Contains 30% Medihoney Antibacterial Honey *Medihoney Derma Cream can be used on large skin areas and under compression or wound dressings to protect intact skin from breakdown and irritation caused by dryness, friction or shear. INDICATIONS FOR USE Protects intact, vulnerable or at-risk skin from breakdown Helps maintain the skin s properties and maintain skin moisture Helps protect the skin from irritation or breakdown caused by dryness, friction or shear Helps maintain the skin ph Helps prevent folliculitis Helps reduce itching SPECIALLY FORMULATED Medihoney Derma Cream is specially formulated with a range of natural ingredients and NO Added colour or fragrance NO Lanolin NO Parabens NO Steroids NO Mineral Oils DIRECTIONS FOR USE Apply to clean, dry skin three times a day or as required. Reapply after bathing or at each dressing change. Suitable for use on children. PRECAUTIONS When using for the first time, patch test on a small area of skin. If irritation occurs discontinue use. ORDERING INFORMATION PRODUCT NAME SIZE SHIPPER QTY Medihoney 50g resealable 24 units Derma Cream tube per box

14 FIRST CHOICE IN SKIN AND WOUND CARE THE SKIN Normal skin has a naturally acidic protective mantle. The acid mantle helps to hydrate the skin by protecting it from drying and from harmful bacteria. Skin ailments such as eczema and dermatitis are linked to a disrupted acid mantle with subsequent colonisation by bacteria such as Staphylococcus aureus. The use of Medihoney Derma Cream helps maintain the skin's protective ph. In vitro studies have shown Staphylococcus aureus to be one of the most sensitive bacteria to Medihoney s Antibacterial Honey. Medihoney Derma Cream contains 30% Medihoney Antibacterial Honey which is proven to be effective against a range of microorganisms. MEDIHONEY ANTIBACTERIAL HONEY Medihoney wound care and skin care products contain medical grade Antibacterial Honey. Advanced biomedical research by Medihoney has identified specific plants that produce honey with exceptional antibacterial activity. The antibacterial activity of honey differs according to the plant species and may vary enormously within any one species. Medihoney Antibacterial Honey is a standardised antibacterial honey, predominantly Leptospermum sp. selected for its broad range of antibacterial actions. In 2007, the journal Wounds featured an article that evaluated the in vitro activity of Medihoney Antibacterial Honey against a challenge set of 127 clinical isolates with multiple antibiotic resistance. The study showed that the Medihoney Antibacterial Honey was effective at inhibiting these bacteria irrespective of their level of antibiotic resistance. Particularly effective against Staphylococcus aureus and MRSA down to a 4% dilution 1. MIC OF 127 DRUG-RESISTANT CLINICAL ISOLATES ( ) Narelle George, Qld Health Pathology and Scientific Services, Royal Brisbane Hospital * nm: non-multiresistant Bacteria Minimum Inhibitory Concentration (MIC). MRSA / nm* MRSA ESBL VRE Acinetobacter Pseudomonas aeruginosa Concentration of Medihoney (%) Antibacterial Honey 0% 2% 4% 6% 8% 10% 12% 14% 16% References: 1. George NM & Cutting K F Antibacterial Honey (Medihoney ): in-vitro Activity Against Clinical Isolates of MRSA, VRE, and Other Multiresistant Gram-negative Organisms Including Pseudomonas aeroginosa. J Wounds; 19(9): Taskapan MO & Kumar P Role of staphylococcal superantigens in atopic dermatitis: from colonisation to inflammation. Annals of Allergy, Asthma, & Immunology; 84(1): 3-10 HEAD OFFICE Comvita New Zealand Ltd Wilson Road South Paengaroa Bay of Plenty 3189 New Zealand NZ Toll Free Facsimile +64 (0) AUSTRALIA Medihoney Pty Ltd BTP Technology & Conference Centre Cnr Miles Platting Rd and Logan Rd Eight Mile Plains QLD 4113 Australia AUST Toll free: Facsimile: +61 (0) EC REP Medihoney (Europe) Ltd The Nova Building Herschel Street, Slough Berkshire SL1 1XS UK UK Toll free: Int Tel: +44 (0) Facsimile: +44 (0) Germany Telephone +49 (0) Facsimile +49 (0)

15 WOUND CARE & PRODUCT SELECTION CHART WOUND TYPE TREATMENT OBJECTIVE PRODUCT SELECTION MODE OF ACTION PRECAUTIONS BLACK, DRY, NECROTIC Rehydrate Debride Wound protection ANTIBACTERIAL WOUND GEL ANTIBACTERIAL MEDICAL HONEY The osmotic action produces an outflow of body fluid helping to lift debris and remove necrotic tissue. The moist wound environment reduces the risk of eschar formation. Provides an antibacterial environment that helps protect the wound. Diabetic and arterial wounds should be managed under clinical care. Protect Wound edges with Medihoney Barrier Cream YELLOW, SLOUGHY Remove slough Rehydrate Wound protection Manage exudate ANTIBACTERIAL WOUND GEL The high osmotic potential of Antibacterial Wound Gel causes a mass flow of bacteria, endotoxins and sloughy material away from the wound bed. This material is then contained in an antibacterial matrix for easy removal at dressing change. Ensure secondary dressing is sufficiently absorbent to accommodate exudate. Protect wound edges with Medihoney Barrier Cream. RED, GRANULATION Maintain moist wound bed Assist wound healing Wound protection Manage exudate ANTIBACTERIAL WOUND GEL Osmotic action brings fluid into the wound providing a moist wound environment to assist the granulation process. Waxes provide a protective coating over the wound, reducing trauma on dressing removal. Antibacterial barrier protects the wound from infection by bacteria. Ensure secondary dressing is sufficiently absorbent to accommodate exudate. Protect wound edges with Medihoney Barrier Cream. PINK, EPITHELIAL Maintain moist wound bed Wound protection Assists wound healing ANTIBACTERIAL WOUND GEL MEDIHONEY MOISTURISING CREAM Provides moist wound environment to encourage the epithelialisation process. Waxes provide a protective coating over the wound, reducing trauma on dressing removal. Antibacterial barrier to protect the wound from contamination and reduces risk of colonisation. INFECTED Reduce infection and colonisation Assist wound healing Clean wound ANTIBACTERIAL WOUND GEL High osmotic potential helps clean the wound and disperse biofilms. Cleaning the wound reduces bacteria loadings, which are a source of inflammatory endotoxins. Provides an antibacterial barrier to protect the wound bed. Protect wound edges with Medihoney Barrier Cream. Clinical care program associated with infected wounds should be followed. CAVITY OR SINUS Aid granulation Assist wound healing Wound protection ANTIBACTERIAL MEDICAL HONEY Absorbs exudate and protects exposed tissue from infecting bacteria, reducing the risk of colonisation. A suitable ribbon/cavity dressing may be saturated with Antibacterial Medical Honey MALODOROUS Remove malodour ANTIBACTERIAL WOUND GEL ANTIBACTERIAL MEDICAL HONEY Inhibits the bacteria that cause odour. Helps clean the wound and lift debris to rapidly reduce odour. PRODUCT SIZE HOSPITAL / PHARMACY NHS LOGISTICS AUTHORITY AVAILABLE QTY CODE QTY CODE ON FP10 Medihoney Antibacterial Medical Honey 20g 1 single use tube PIP box of 20 tubes ELZ015 YES Medihoney Antibacterial Wound Gel 10g 1 single use tube PIP box of 20 tubes ELZ013 YES 20g 1 single use tube PIP box of 20 tubes ELZ014 YES HEAD OFFICE Medihoney Pty Ltd 399 Archerfield Road, PO Box 66, Richlands Qld Australia 4077 Tel: +61 (0) AUS Toll Free Fax: +61 (0) EUROPE Medihoney (Europe) Ltd 200 Brook Drive, Green Park, Reading Berkshire RG2 6UB United Kingdom Tel: +44 (0) UK Toll Free Fax: +44 (0) Germany Tel: +49 (0) Fax:+49 (0) info@medihoney.com

16 THE ORIGINAL WOUND CARE SOLUTION ADVANCED WOUND CARE Medihoney wound care and skin care products contain a uniquely formulated medical grade Antibacterial Honey. Medihoney Antibacterial Medical Honey dressing contains 100% Antibacterial Honey whereas Medihoney Antibacterial Wound Gel contains 80% Antibacterial Honey. Skin care products contain 30% Antibacterial Honey. Medihoney s products use the powerful inhibitory action of Medihoney s Antibacterial Honey to protect wounds from infection; The natural cleaning action of Medihoney s wound care products helps clean wounds of sloughy and necrotic tissue; The strong deodorising action of Medihoney s wound care products rapidly eliminates unpleasant smells from wounds; The low ph of honey helps control protease activity. ANTIBACTERIAL PROTECTION Medihoney s Antibacterial Honey has been independently screened against over 200 clinical isolates. 1,2,3,4,5 Staphylococcus aureus, including drug resistant strains, is inhibited by Medihoney Antibacterial Honey even after a 25 fold dilution. The yeasts Candida albicans, Zygosaccharomyces rouxii and the fungus Aspergillus Niger are also inhibited by Medihoney Antibacterial Honey. WOUND CLEANING Wound cleaning products are designed to provide a moist wound environment, rehydrate necrotic tissue and support autolytic debridement and slough removal. The use of these products can be limited by the possibility of bacteria overgrowth. Medihoney s wound care products have high osmotic potential, natural hydrolytic enzymes and inhibit bacterial growth. The high osmotic potential gives Medihoney wound care products a capacity for absorption. Combined with the benefit of the antibacterial properties to help protect the wounds from colonising bacteria, Medihoney wound care products help clean necrotic and sloughy wounds and contain bacterial growth. ANTIBACTERIAL BARRIER AND ODOUR CONTROL Excess microbial growth in the wound is responsible for unpleasant odours. The judicious use of an antibacterial barrier to protect wounds from bacterial growth is advantageous in reducing odour. The antibacterial activity of the honey used by Medihoney Antibacterial Honey has been assessed against most common wound infecting organisms including antibiotic resistant strains. PROTEASE INHIBITION Proteases are enzymes that play an essential role in epithelialisation by facilitating the removal of damaged components and assisting in the restructure of the basement membrane. If the expression of protease is uncontrolled, damage to the extracellular matrix and prevention of the migration and attachment of keratinocytes can occur, adversely impacting on the healing process. Protease activity may also adversely affect important growth factors. Peak protease enzyme activity occurs at ph 7 to ph 9. The ph of chronic wounds varies between 5.5 and 8.7. Adjustment of the wound environment to a ph below 6 may help reduce proteolytic activity. 6 Medihoney wound care products have a low ph. The ph is also strongly buffered by the natural production of gluconic acid. If the antibacterial honey is diluted, glucose is converted into gluconic acid and hydrogen peroxide, maintaing a low ph. The low ph wound environment created by Medihoney Antibacterial Honey application will therefore assist the healing process of chronic wounds. 1. George NM Honey antimicrobial agent au naturel. Paper presented at the Australian Infection Control Association Third Biennial Conference, Hobart, June 2. Blair S Honey and Drug Resistant Pathogens. Paper presented at Joint Scientific Meeting of the Australian Society for Microbiology, Cairns, July 3. Irish J et al Honey has an antifungal effect against Candida species. Med Mycol; 44(3): Lusby PE, Coombes AL, Wilkinson JM Bactericidal activity of different honeys against pathogenic bacteria. Arch Med Research; 36: Wilkinson JM, Cavanagh HMA Antibacterial activity of 13 honeys against Escherichia coli and Pseudomonas aeruginosa. J Med Food; 8(1): Greener B et al Proteases and ph in chronic wounds. J Wound Care; 14(2): 59-61

17 TECHNICAL INFORMATION ADVANCED WOUND CARE Medihoney wound care and skin care products contain a uniquely formulated medical grade Antibacterial Honey. Medihoney Antibacterial Medical Honey contains 100% Antibacterial Honey whereas Medihoney Antibacterial Wound Gel contains 80% Antibacterial Honey. Skin care products contain 30% Antibacterial Honey. Advanced biomedical research by Medihoney has identified specific plants that produce honey with exceptional antibacterial activity. The antibacterial activity of honey differs according to the plant species and may vary enormously within any one species. Medihoney Antibacterial Honey is made up of honey from Leptospermum sp. and several other plant species to benefit from a broad range of antibacterial action. Medihoney grades each Antibacterial Honey using a validated testing procedure conducted by a NATA (National Association of Testing Authorities) accredited laboratory. In association with the Institute of Molecular BioScience we monitor the chemical fingerprint of the honeys used to help standardise for consistency. Medihoney s Antibacterial Honey has been independently screened against over 200 clinical isolates. 1,2,3,4,5 Staphylococcus aureus, including drug resistant strains, is inhibited by Medihoney Antibacterial Honey even after a 25 fold dilution. The yeasts Candida albicans, Zygosaccharomyces rouxii and the fungus Aspergillus Niger are also inhibited by Medihoney Antibacterial Honey. Medihoney s products use the powerful inhibitory action of Medihoney s Antibacterial Honey to protect wounds from infection; 6 The natural cleaning action of Medihoney s wound care products helps clean wounds of sloughy and necrotic tissue; 7 The strong deodorising action of Medihoney s wound care products rapidly eliminates unpleasant smells from wounds; 8 The low ph of honey helps control protease activity. BACKGROUND ON MEDIHONEY ANTIBACTERIAL HONEY In the Australian flora there are more than 25,000 species of plants grouped into around 2,700 genera 9. Most of the modern Australian flora had its origin in the Cretaceous period while Australia was a part of Gondwana. This rich floral diversity provides hundreds of species of plants that produce nectar in sufficient quantity to be of benefit to the bees, giving Australia one of the richest varieties of different honeys of any continent. Each plant species produces honey with a unique chemical composition, referred to as its chemical fingerprint. One plant genus, Leptospermum, which originated on the east coast of Australia 10, can produce honey that has an exceptional antibacterial activity. Current biomedical research has shown that the antibacterial action of honey from Leptospermum sp at low concentrations is more stable than the antibacterial action in honey from any other plant (Medihoney Antibacterial Honey is substantially based on honey from Leptospermum sp.). The genus Leptospermum, of which there are over 80 species, dispersed relatively recently from Eastern Australia to New Zealand, New Guinea, and South East Asia 10. The unique antibacterial activity is not consistent and varies enormously. It has only been found in Leptospermum sp. growing in Australia and one Leptospermum sp. growing in New Zealand. By percent of composition the major components of honey are the sugars: fructose, glucose, sucrose and sugar polymers. The ratio of sugars depends on hydrolytic activity of natural enzymes in honey. In addition honey contains acids with the average ph being 3.9. Gluconic acid is the principal acid of honey. It is produced by the action on glucose of the enzyme glucose oxidase and produces hydrogen peroxide. This action is very slow in pure honey but rapid when the honey is diluted. glucose + water + O gluconic 2 acid glucose oxidase + hydrogen peroxide There are many other acids known to exist in honey. Some of these acids are known to have antimicrobial properties but their presence is variable. In addition honey is composed of a comprehensive range of lesser compounds, some have yet to be fully characterised. Their presence is also variable and dependent amongst other things on the plant source of the honey. ANTIBACTERIAL ACTIVITY An important attribute of the unique blend of honeys used in Medihoney s wound care products is their natural antibacterial activity and effectiveness in inhibiting drug resistant bacteria such as Methicillin resistant Staphylococcus aureus (MRSA). When honey is applied to the wound bed, gradual dilution occurs at the wound bed/honey interface. The antibacterial honey used in Medihoney wound care products differs from most other honeys in that it maintains its antibacterial activity even when substantially diluted.

18 ANTIBACTERIAL ACTIVITY CONTINUED In 2004 an Australian State Government Health Pathology and Scientific Services Department evaluated the in vitro activity of Medihoney Antibacterial Honey against a challenge set of 127 clinical isolates with multiple antibiotic resistance. These organisms comprised of: 20 strains of Methicillin Resistant Staphylococcus aureus (MRSA), 28 strains of Non-Multiresistant Methicillin Resistant Staphylococcus aureus (nmmrsa), 20 vancomycin resistant enterococci (VRE), 28 extended spectrum beta-lactamases producing strains (ESBL is an enzyme produced by some bacteria which breaks down certain types of antibiotics.), 20 Pseudomonas aeruginosa and 11 Acinetobacter baumanni. The study showed that the Medihoney Antibacterial Honey was effective at inhibiting these bacteria irrespective of their level of antibiotic resistance. All test strains of MRSA were inhibited at concentrations of 4% v/v. VRE were inhibited at concentrations between 6-8% depending upon the species. ESBL producing gram negative bacteria were inhibited at 6-8% v/v irrespective of the species tested. Pseudomonas aeruginosa was inhibited at between 12 and 14% v/v and 11 multi-resistant Acinetobacter baumanni were inhibited at concentrations of 8% v/v. PROTEASE INHIBITION Proteases are enzymes that play an essential role in epithelialisation by facilitating the removal of damaged components and assisting in the restructure of the basement membrane. If the expression of protease is uncontrolled, damage to the extracellular matrix and prevention of the migration and attachment of keratinocytes can occur, adversely impacting on the healing process. Protease activity may also adversely affect important growth factors. Peak protease enzyme activity occurs at ph 7 to ph 9. The ph of chronic wounds varies between 5.5 and 8.7. Adjustment of the wound environment to a ph below 6 may help reduce the proteolytic activity 11. Medihoney wound care products have a low ph. The ph is also strongly buffered by the natural production of gluconic acid. If the Medihoney Antibacterial Honey is diluted, glucose is converted into gluconic acid and hydrogen peroxide, maintaing a low ph. The low ph wound environment created by Medihoney Antibacterial Honey application will therefore assist the healing process of chronic wounds. WOUND CLEANING Wound cleaning dressings are designed to provide a moist wound environment, rehydrate necrotic tissue and support autolytic debridement and slough removal. The use of these products can be limited by the possibility of bacteria overgrowth. Medihoney s wound care products have high osmotic potential, natural hydrolytic enzymes and inhibit bacterial growth. The high osmotic potential gives Medihoney wound care products a capacity for absorption. Combined with the benefit of the antibacterial properties to help protect the wounds from colonising bacteria, Medihoney wound care products help clean necrotic and sloughy wounds and contain bacterial growth. ANTIBACTERIAL BARRIER AND ODOUR-CONTROL It is generally agreed that excess microbial growth in the wound may lead to excess inflammatory cell activity and consequential delays in wound healing. Bacteria in heavily colonised wounds are also responsible for unpleasant odours. The judicious use of an antibacterial barrier to protect wounds from bacterial growth is advantageous in reducing odour. The antibacterial activity of the honey used by Medihoney Antibacterial Honey has been assessed against most common wound infecting organisms including antibiotic resistant strains. These organisms were inhibited in a range of 4% - 15% Medihoney Antibacterial Honey. REDUCE DEPENDENCE ON TOPICAL ANTIMICROBIAL PRODUCTS Expert Advisory Committees on Antimicrobial Resistance are highlighting a concern that the misuse of antibiotics could render these drugs useless. The increasing prevalence of antibiotic resistant bacteria, especially those with multiple resistances, is causing international concern. Antibiotic resistance makes infections more difficult to treat, increases the length and severity of illness, the period of infectiousness, adverse reactions (due to the need to use less safe alternative drugs), length of hospital admission and costs 12. The prophylactic use of antibiotics has been shown to significantly reduce infection rates. However the use of antibiotics in this manner leads to the selection of antibiotic resistant bacteria. In a recently published randomised trial comparing Medihoney Antibacterial Honey against Mupirocin as a prophylactic for the prevention of catheter associated infections, the authors noted that the Medihoney Antibacterial Honey was safe, cheap and effective and did not select for antibiotic resistant strains 6. Given the evidence to date on the properties of the antibacterial honey used in Medihoney products, and its equivalence to a leading antibiotic when used as a prophylactic to protect wounds, Medihoney wound care products are ideally suited to reduce the dependence on topical antibiotics. SKIN PROTECTION Medihoney barrier creams and moisturising creams contain 30% Medihoney Antibacterial Honey and natural oils to protect and moisturise the skin. Some common bacteria can aggravate atopic dermatitis. Super-antigens from Staphylococcus aureus may be an important triggering factor in atopic dermatitis 13. In vitro studies have shown Staphylococcus aureus to be one of the most sensitive bacteria to Medihoney s Antibacterial Honey. Use of Medihoney creams helps protect the skin from these colonising bacteria. 1. George NM Honey antimicrobial agent au naturel. Paper presented at the Australian Infection Control Association Third Biennial Conference, Hobart, June 2. Blair S Honey and Drug Resistant Pathogens. Paper presented at Joint Scientific Meeting of the Australian Society for Microbiology, Cairns, July 3. Irish J et al Honey has an antifungal effect against Candida species. Med Mycol; 44(3): Lusby PE, Coombes AL, Wilkinson JM Bactericidal activity of different honeys against pathogenic bacteria. Arch Med Research; 36: Wilkinson JM, Cavanagh HMA Antibacterial activity of 13 honeys against Escherichia coli and Pseudomonas aeruginosa. J Med Food; 8(1): Johnson DW et al Randomised controlled trial of topical exit-site application of honey (Medihoney ) versus Mupirocin for the prevention of catheter-associated infections in haemodialysis patients. J Am Soc Nephrol; 16(5): White R and Acton C Honey in modern wound management. MIMS Dermatology; 2(1): Dunford C and Hanano R Acceptability to patients of a honey dressing for non-healing venous leg ulcers. Journal of Wound Care; 13(5): Thiele KR & Adams LG (eds) Families of Flowering Plants of Australia. CSIRO Publishing / Australian Biological Resources Study (ABRS), Melbourne 10. Thompson J A revision of the genus Leptospermum (Myrtaceae). Telopea; 3(3): Greener B et al Proteases and ph in chronic wounds. J Wound Care; 14(2): Specialist Advisory Committee on Antimicrobial Resistance UK Antimicrobial Resistance Strategy and Action Plan. UK Department of Health 13. Taskapan MO & Kumar P Role of staphylococcal superantigens in atopic dermatitis: from colonisation to inflammation. Annals of Allergy, Asthma, & Immunology; 84(1): 3-10