Maggots are useful in treating infected or necrotic wounds

Editor—In their editorial Wise et al highlight the problems of the development of antibiotic resistant bacteria and outline several strategies to combat this problem.¹ We propose another option: the use of fly larvae (maggots) to treat infected or necrotic wounds.

This technique was described in detail in the medical press in the early part of this century and has been reintroduced in the United Kingdom and elsewhere with considerable success over the past three years. To date, over 3500 containers of sterile larvae of Lucilia sericata, the common greenbottle, have been supplied to nearly 400 centres.

Clinical indications for larval treatment, or “biosurgery,” include infected or necrotic wounds of all types, including those infected or colonised with antibiotic resistant strains of bacteria such as methicillin resistant Staphylococcus aureus.² Particularly spectacular results have been reported in the treatment of feet in diabetes.³

The mechanisms by which larvae kill bacteria in wounds are not fully understood but may include the production of natural antibiotic-like agents,⁴ the modification of wound pH, and the ingestion and destruction of bacteria as part of normal feeding processes. Growth promoting agents have also been detected in larval secretions,⁵ a finding that is consistent with the clinical observation that the introduction of larvae often causes a previously indolent wound to heal rapidly.

Currently, many patients receive larval treatment as the last resort, when conventional treatments, including repeated courses of antibiotics, have failed. We suggest that the earlier application of maggots should be considered to clean up problem or infected wounds at an earlier stage, which in many cases would obviate the need for topical or systemic antimicrobial treatment.

More information on larval treatment may be found at www.smtl.co.uk.