The use of live maggots to clean wounds is undergoing a renaissance in the UK National Health Service amid mounting concerns about the threat of antibiotic resistance.
The treatment – which involves applying sterilised fly larvae to wounds to eat away dead tissue – was common in the first half of the 20th century, but the use of live maggots faded with the advent of the “antibiotic era” in the 1940s.
But now, with antibiotic resistance making some wounds much harder to treat, maggots are again being used in the NHS and overseas. Already, superbugs kill roughly 700,000 people a year – a figure predicted to hit 10 million by 2050 if AMR continues at its current rate.
BioMonde, a wound care company based in Bridgend, South Wales, rears maggots from Greenbottle Blowflies and sells some 25,000 “biobags” containing the insects across Europe annually – including 9000 to the NHS.
The bags, each containing between 50 and 400 live maggots, are placed on wounds that won’t heal with antibiotics. The maggots eat away the rotten flesh, containing and killing off the infection.
“Maggots are viewed as an agent of decay, when in fact they’re brilliant little creatures… and work incredibly well in wounds with resistant infections,” Yamni Nigam, a professor of healthcare science at Swansea University, told The Telegraph.
“We’re on the cusp of this global catastrophe of antimicrobial resistance and larval therapy is sometimes considered a backup plan or last resort to tackle resistance – but actually it is part of the solution.”
Larval therapy has 'stood the test of time'
The use of live maggots was first popularised among medics by an American scientist, William Baer, who used them to treat soldiers’ wounds during the First World War. But their use has been traced back to aboriginal and indigenous communities centuries ago.
“It’s a tried and trusted treatment that has stood the test of time for hundreds, if not thousands, of years,” said Rebecca Llewellyn, a clinical support assistant at BioMonde. “[It] is considered by some as an old-fashioned treatment, but it is definitely useful in a modern setting.”
In the NHS the biobags, or “maggot teabags”, are typically wrapped around a wound – such as a diabetic ulcer or trauma injury – for two to four days.
The maggots don’t have teeth, but instead excrete enzymes which break down dead tissue and turn it into a “soup that they then drink” through the polyester pouch, said Nigam. The larvae’s saliva then acts as a natural disinfectant, but mounting evidence has shown it also aids the healing process.
Not surprisingly perhaps, the biobags – which cost between £150 and £300 each – are more popular than the “free range” maggots, which crawl unencumbered over a wound, Ms Llewellyn said. But she added that the “yuck factor” among both patients and clinicians remains a barrier to broader use.
'Ikea manual' for maggot therapy in war zones
However internationally, experts believe free range larval therapy has “immense potential” to transform treatment of wounds in lower resource settings – especially war zones and humanitarian crises, where access to medical supplies is more limited and it is common to die or lose a limb from a secondary infection after even a simple procedure.
This week the Australian-based company MedMagLabs – whose work on larval therapy was part funded by UK aid via the Humanitarian Grand Challenge programme – published a do-it-yourself “Ikea style manual” for medicinal maggot at low cost in remote regions.
The instructions, which are available for free online, explain how to build and operate a basic production laboratory for medicinal maggots, plus how to use the larvae to safely treat wounds.
“The manuals we’ve developed do not require medication from a chemist, or any fancy laboratory gadgets,” Dr Frank Stadler, team leader at MedMagLabs, told The Telegraph.
“They simply require a cardboard box, some jam jars and bleach, and we explain how to harvest eggs from flies and sterilise the larvae.”
He added: “There is an old adage saying ‘Give a man a fish and you feed him for a day, teach a man to fish and you feed him for a lifetime.’ MedMagLabs believes that this also holds true for wound care.
“We teach communities to grow their own medicinal maggots so they become self-sufficient and can treat their loved ones with local resources,” Stadler said.
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