Maggot ulcer treatments questioned

20 March 2009 07:42am

The use of maggots to treat leg ulcers may be more painful but no quicker than standard gel treatments, researchers have said.

Scientists at the University of York found little difference when they compared patients treated with maggots with those treated with a standard "hydrogel", but added that larval therapy was "associated with twice as much pain".

The study in the BMJ, formerly the British Medical Journal, is the first to compare maggots with standard treatment in terms of clinical and cost-effectiveness and appeared to contradict suggestions that larval therapy removes dead tissue from wounds more swiftly.

The researchers found there was "no difference between larvae and hydrogel groups in health-related quality of life or in bacterial load (including MRSA)" but added that: "Larval therapy was associated with twice as much pain in the 24 hours prior to removal of the first application compared with hydrogel.

"There is no evidence from this trial that it should be recommended for routine use on sloughy leg ulcers (leg ulcers with dead tissue) with the aim of speeding healing or reducing bacterial load," said the researchers, led by Marta O Soares, a research fellow in the university's department of health sciences.

They suggested that "the nature of the uncertainty associated with our results is such that larval therapy is likely to be as costly and as effective as hydrogel.

"In conclusion, one phase of larval therapy... is likely to produce a similar level of health benefit at a similar cost to hydrogel," the report said.

"It could be argued that healthcare decision-makers should be indifferent when recommending these two therapies for the treatment of sloughy or necrotic leg ulcers or that the decision should be driven by the goal of treatment.

"The choice of treatment may then be driven by patients' wishes and experiences of pain with larvae."

Leg ulcers are chronic wounds most commonly caused by diseased veins in the legs.

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