Maggots in ‘teabags’: Is it time to resurrect this ancient solution to antibiotic resistance and wound care?
Dr Stadler says maggots are “fantastic” for wound care and shouldn’t be used as a last resort. (ABC Gold Coast: Damien Larkins)
They have a long history dating back to tribal and ancient medicine, and maggot therapy is slowly crawling back for therapeutic medicinal purposes in Australia.
Frank Stadler, a Griffith University adjunct research fellow, has received international recognition for his project studying the use of maggots for therapeutic medicinal purposes in war zones and other compromised health care settings.
But he said the healing benefits of blowfly larvae were being missed in the Australian health care setting.
“Maggots are fantastic. They remove dead tissue. They eat all the dead and decaying tissue in the wound,” he said.
WARNING: Some of the images that follow may be distressing.
Dr Stadler said the other benefit was that they sterilised a wound.
“They remove bacteria by eating them and digesting them, and through their excretions and secretions that they place into the wound. So they have anti-microbial properties,” he said.
“This controls the infection sufficiently for the body to heal the wound.”
In September, Dr Stadler’s research project at Griffith University was recommended for a $250,000 funding grant by Humanitarian Grand Challenge Canada.
He believed the research could “make a real contribution to life and limb-saving wound care in conflict” but more than that, he said the value of the humble maggot would increase as antibiotic resistance increases in the community.
“Penicillin is losing its potency in the era of antibiotic resistance,” he said.
“Maggot therapy has been efficient in antibiotic resistant infections like staph infections.”
How clean do the maggots have to be?
Medicinal maggots are beneficial for cleaning ulcers and wounds. (Supplied: Stephen Doggett/Department of Medical Entomology, Westmead Hospital)
Maggot treatment has been used in indigenous communities, ancient medicine, and during the First and Second World Wars.
“In recent times, since World War I, maggot therapy has been used in the modern clinical settings,” Dr Stadler said.
The maggots used in clinical settings are, however, sterile.
“We harvest maggots from the wild. Then we establish a colony, a fly colony, then the fly colony is maintained, eggs are harvested in a sterile way so the larvae emerging from the eggs are sterile when they are placed onto wounds that require treatment,” he said.
However, even in accidental infestations of wounds by maggots which are not sterile, they too deliver “fantastic” results.
Remember the scene in the Gladiator movie where Maximus — played by Russell Crowe — had maggots applied to his seeping wound?
“In many cases today when people present to hospital with maggot-infested wounds, the health care professionals have to admit that the wounds look perfect, they look fine,” Dr Stadler said.
In modern clinical therapy, maggots are applied directly to the wound with a net dressing that works like a fly screen to keep the maggots in place.
He said alternatively they can be sealed into a tea bag-like pouch and placed on the wound, which means they can be applied gently and non-offensively.
“This works because maggots don’t have chewing mouthparts, they first liquefy the dead tissue with excretions and then suck their food up,” he said.
Maggots stay on the wound for a maximum of two to four days, after which they are removed and new maggots are reapplied if need be.
What’s it like to have maggots on your wound?
In Australia, Westmead Hospital in Sydney is the only supplier of sterile maggots, so while their use is somewhat limited, there is an interest among those patients who become desperate when all other treatment options fail.
Mark Zanker had tried numerous treatments before turning to maggot therapy. (Supplied: Mark Zanker)
Mark Zanker, 57, was living at Cootamundra in regional New South Wales when, out of desperation, he ordered a batch of maggots earlier this year.
He had tried numerous treatment options for a condition which he later learned to be misdiagnosed cellulitis.
“I was getting pretty desperate because the cellulitis kept recurring,” Mr Zanker said.
“I did encounter some resistance from my general practitioner but I just insisted on proceeding.”
Desperate for a solution to a wound on his leg, Mark Zanker turned to maggot therapy. (Supplied: Mark Zanker)
The specimen sample-type jar arrived at his home in a foam esky, cushioned with ice packs.
“That arrived pretty much overnight … and you have to use them pretty quickly otherwise they die,” he said.
“I went to the doctor and he and the nurse applied them on the leg and covered it up.”
He estimated about 50 maggots were applied to his four square centimetre wound.
“It didn’t feel itchy, and frankly, I didn’t notice that they were there,” Mr Zanker said.
“I left them on for 24 hours and went back, the bandaging was taken off and the maggots disposed of.”
While some may baulk at the treatment, Mr Zanker said he took comfort in the historical use of maggots in Aboriginal communities and WWII.
The treatment turned out to be ineffective for his current condition, but he believed it would have helped with a previous leg ulcer.
“What they like is decaying flesh and I’d rather have them come and clean up my decaying flesh than put up with the decaying flesh,” he laughed.
“I can understand people might be squeamish about it. These medicinal ones [maggots] are tiny, like little white threadworms, but I had no hesitation.
“I’d say give it a go. It may not work, but on the other hand it might provide you with a great deal of relief.”
‘Promising’ treatment for diabetics
Dr Stadler said it was unfortunate that maggot therapy was perceived to be a last resort treatment in Australia.
“It is ideally suited for early interventions,” he said.
“When someone presents with a diabetic ulcer, maggot therapy is fantastic in treating that ulcer and setting the wound up for healing.”
Peter Lazzarini, a principal research fellow at QUT and co-chair of Diabetic Foot Australia, said a handful of small studies have tested maggot therapy on diabetic foot ulcer patients with mixed results.
“Maggot or larval therapy has been shown to be pretty effective in scientific labs at essentially gobbling up this devitalized tissue without touching the healthy ulcer tissue,” he said.
“The rationale for using larval therapy is promising, but we need larger studies to prove if it is as effective, or more effective, than other forms of debridement yet.”
While he has not used the technique on patients, Dr Lazzarini said he was aware of cases where it had been used for complex wounds where removing the tissue with a scalpel proved difficult.
“The larvae seem to be pretty good ‘debriders’ in these cases,” he said.