The Doctor Weighs In

Maggots. They are fly larvae. Yuck, you think. Double yuck, if you have ever seen them. But, wait a minute, we have known for a long time that maggots can clean infected wounds. It’s just darn hard to explain to a patient and his or her family.

“Hi, Mr. Smithy, you have a nasty infection there, but we have just the treatment for you. We’ll just smear some fly larvae in your wound and let them have their way.”

There are reputable studies of this practice. To pretty it up, however, the researchers have come up with names that make it seem more sophisticated than it really is. One article used the term “maggot debridement therapy,” no doubt referred to as MDT. A recent article in the well-respected and well-read journal, Diabetes Care, has cleaned up the name even more in an article titled: “Larval therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus from Diabetic Foot Ulcers.”

Let me translate – overuse of antibiotics has led to a proliferation of bacteria that are resistant to commonly used antibiotics. One such bacterium, Staphylococcus, is a common cause of skin infections. Methicillin-resistant Staphylococcus aureus (aka MRSA) is a serious infection that is hard to treat with conventional methods. Diabetics are prone to getting foot ulcers because they have compromised circulation to the lower extremities and because they often have nerve damage so they don’t feel the initial injury. When a diabetic gets an ulcer infection that is hard to treat, such as a MRSA infection, the end result can be amputation -- sometimes it is just a toe or two, sometimes it is the foot or even the entire lower leg. This is a serious problem that requires aggressive treatment.

So back to the Larval Therapy article. It is actually pretty interesting even though it is only an observational study, and not the gold standard in medical research, the randomized clinical trial. The researchers, led by Frank Dowling, a podiatrist at the University of Miami School of Medicine in Florida, applied “sterile, free-range” (free-range?) larvae of the green bottle fly Lucilla sericata to MRSA colonized ulcers in 13 diabetic patients. 12 of the 13 people who received this treatment were MRSA free after an average of three such treatments over about 19 days.

Caveats here are that this is not a randomized controlled trial (RCT). Something other than the maggots could have coincidentally been responsible for the elimination of MRSA colonization. But it is intriguing. Eradication of a serious bacterial contaminant from a diabetic wound with a simple, non-invasive (albeit yucky) treatment catches your eye. Hopefully, researchers will follow-up on this early report with well-designed clinical trials.