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Sunday, October 27, 2013

Maggots as Medicine

Experts estimate that we spend more than 20 billion dollars each year trying to treat non-healing wounds like pressure ulcers and diabetic foot ulcers. Each year there are more than 1.5 million cases of diabetic foot ulcers alone, and they're responsible for at least 70,000 amputations.

These non-healing wounds, along with the rise of antibiotic resistance and life-threatening infections, has prompted scientists and doctors alike to revisit an age-old therapy: maggots.

Maggot therapy, also referred to as maggot debridement therapy (MDT), larval therapy, or biodebridement, is the application of live, sterilized fly larvae to wounds. The larvae do not feed on live tissue and they do not reproduce. Maggots secrete an enzyme that disinfects the wound, dissolves dead tissue, and promotes healing. They've even been shown to be effective against MRSA (methicillin-resistant Staphylococcus aureus infection) and other resistant germs.

Controlled clinical and laboratory studies show that compared to conventional medical and surgical care, maggot therapy is safer, faster, cheaper, more accurate, and more effective. Patients who use MDT require fewer days of antibiotics and their wounds heal an average of 4 weeks earlier. And it's 100% natural.

Used as a last resort, maggot therapy has reportedly saved 40 to 50 percent of limbs that would otherwise have been amputated. Researchers attribute the limb-saving success to increased oxygen supply, cell regeneration, and tissue remodeling triggered by maggot secretions.

Maggot therapy costs about half as much as conventional therapy, and sometimes much less. A study in the UK found that treating a patient with maggot therapy cost £92 while treating a patient with antibiotics cost £319, making MDT almost three and a half times less expensive than antibiotic therapy.

Maggot therapy was so popular in the 1930s that hospitals kept their own insectaries, where they reared and sterilized their own larvae.  As antibiotics became available and surgical techniques improved, MDT lost popularity in the 1940s and virtually disappeared in the 1950s.

Now it's making a comeback. As of  2009, at least 24 laboratories supplied medical-grade maggots to doctors and patients in more than 50 medical centers in North America and more than 850 in the United Kingdom. Maggot therapy is being used in at least than 30 countries around the world. 

In the United States, maggots were the first live organisms recognized as medical devices by the Food and Drug Administration in 2004. MDT requires a prescription but it's reimbursable by Medicare and many insurance companies.

References:

Dente KM. 2007. Alternative Treatments for Wounds: Leeches, Maggots, and Bees. Medscape. http://www.medscape.com/viewarticle/563656.

Ryan R. Why maggots and leeches are good for your health. Daily Mail. http://www.dailymail.co.uk/health/article-130983/Why-maggots-leeches-good-health.html.

Sherman RA. 2009. Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century. Journal of Diabetes Science and Technology 3(2):336-44.

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