Maggots
Scientific Name(s): Lucilia sericata, Phaenicia sericata
Common Name(s): Botfly maggot, Fly larva, Grub, Living antiseptic, Maggot, Surgical maggot, Viable antiseptic
Medically reviewed by Drugs.com. Last updated on Sep 20, 2021.
Clinical Overview
Use
Maggot debridement therapy (MDT) is used in persistent ulcers, especially pressure ulcers and diabetic-related ulcers, although other wound applications have been reported. Cost effectiveness of the therapy, as well as effectiveness in reducing time to heal, has not been established.
Dosing
Standards for the growth and harvesting of P. sericata larvae have been published, and have been accepted by the Food and Drug Administration (FDA) in the approval of maggots in the medical management of wounds. Estimates of the quantity of maggots required for debridement include the use of 10 maggots per cm2 of wound and 100 maggots per 50 g necrotic tissue over 4 days.
Contraindications
Contraindications may include life- or limb-threatening conditions, lack of wound hemostasis, deep-tracking wounds, psychological issues, and hypersensitivity. With wounds, contraindications may only exist until underlying pathology is addressed (ie, maggots have been successful in osteomyelitis and limb-threatening conditions).
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
None well documented.
Adverse Reactions
When used therapeutically, maggots do not appear harmful to living tissues, but can produce pain and pruritus, as well as anxiety. Severe bleeding has resulted from maggot therapy.
Toxicology
Information regarding the toxicology of maggot exudate is limited.
Biology
Maggots are the larvae of various flies. The species P. sericata (green blow fly) has been therapeutically used with success for many decades, but other species such as Lucilia caesar, Phormia regina, and Musca domestica have also been used.Claxton 2003, Li 2009 Standards for the growth and harvesting of P. sericata larvae have been published and have been accepted by the FDA for approval in the medical management of wounds. The second instar (stage) larvae are used to feed on tissue material before they develop into nonfeeding pupae after 5 to 7 days. These are removed before they enter the 1- to 3-week–long pupation stage leading to adult flies.Claxton 2003, FDA 2010, Sherman 2002, Sherman 1996
History
The effects of maggots on wounds have been known since the 1500s when it was observed that maggots cleaned untreated wounds, removing necrotic tissue without apparent harm to living tissue. Later, some military surgeons noticed that maggot-infested wounds responded better than noninfested wounds. The first scientific paper on the surgical use of maggots appeared in 1931, and interest in the technique continued throughout the 1930s and early 1940s. MDT was routinely performed in over 300 hospitals during this time. The first civilian use, based on observations during World War I, was in treating 4 children with osteomyelitis who did not respond to other available treatments. Subsequent occurrence of tetanus in other cases led to the development of bacteriologically sterile maggots. Early uses for maggot therapy included the treatment of abscesses, burns, cellulitis, gangrene, and ulcers. The use of maggots declined rapidly in the mid-1940s with the development of antibiotic drugs, but more recent cost-effectiveness evaluations and acceptability studies suggest a resurgence in interest.Claxton 200...
