Medieval remedies undergo a renaissance

Maggot therapy is just one form of old-fashioned medicine finding uses in the 21st century.

By Victoria Stagg Elliott, AMNews staff. Oct. 7, 2002. Additional information

Leeches to improve blood flow after surgery. Bee stings to alleviate the symptoms of multiple sclerosis or arthritis. Maggots for bedsores.

How is it that these old-fashioned remedies have, for some, found a place in the midst of 21st-century medicine -- the age of stem cells, surgical robots and genetics? It may seem strange, but it appears that some of the very treatments that fell out of favor because of the development of antibiotics and other medical marvels are now coming back into vogue.

"Doctors are becoming aware that all this modern stuff we do isn't really cutting it, and we're looking for alternatives," said Edgar Maeyens Jr., MD, a Coos Bay, Ore., dermatologist who uses maggots regularly in his practice. "And society is looking for alternatives."

Leeches re-emerged a while ago and now have a well-established role in plastic and reconstructive surgery. Research into a nonbiological substance that mirrors their active ingredient has thus far been unsuccessful. Maggots are being considered more often for treatment of chronic wounds that do not heal. But bee venom is still considered alternative medicine.

These age-old preparations are drawing interest and being subjected to scientific rigor.

Beyond the "ick" factor, results

A paper published in the Sept. 9 Archives of Internal Medicine described six patients in Austria with refractory skin ulcers effectively debrided with maggots. A much larger study of patients with chronic wounds in California was published in Wound Repair and Regeneration in August. That paper concluded that maggots did a better job than more conservative therapy for pressure ulcer treatment.

In both studies, patients tolerated the creatures, although the Austrians did report that some complained of a "tickling sensation." In general, it appeared that wounds healed more quickly and with less pain.

Maggots do not eat living flesh.

"Most other products or procedures either debride at the expense of viable tissue as well or kill bacteria along with young proliferating cells or promote healing but also promote bacterial proliferation," said Ronald A. Sherman, MD, author of the paper in Wound Repair and assistant professor of medicine at the University of California, Irvine. "Maggot therapy debrides more quickly than nonsurgical methods, and more specifically than any other product or procedure."

Physicians who use maggots in their practices say they like them because they work. They go into a wound devouring the dead flesh and have no taste for the living.

"There are ulcers that are just necrotic and unresponsive to these fancy, expensive $400 tubes of genetically engineered creams," said Dr. Maeyens. "I am enamored with the little creatures."

But they do have their challenges. The creatures must be handled delicately or they will die, and they are sometimes damaged in shipping. They must also be used within a few days before they grow up and become flies.

"Sometimes they seem livelier than other times when you get them because of the variations in handling procedures," said Terence McDonald, MD, a chronic wound care specialist in Wichita, Kan. "But in general they do fairly well."

Reimbursement can sometimes be a fight. Maggots take days rather than minutes to get the job done, although this is less important for chronic wounds. Also, the "ick factor" can get in the way. Still, doctors say this is more likely a problem for caretakers than for patients.

"Patients are usually a little unnerved by the idea at first, but most of them are OK with it," Dr. McDonald said. "Some patients' families also get really upset if they get loose."

But 21st-century technology may ultimately help reduce this response. Experts speculate that the emerging science of genetics may make maggots better, smarter and stronger.

"It is conceivable that someday they might be able to genetically alter these guys so that they would be faster and much more efficient and not have the unpleasant fly aspect," said Eric Mooney, MD, an attending plastic surgeon at Bassett Healthcare in Cooperstown, NY.

ADDITIONAL INFORMATION:

Good bugs

Study question: How does maggot debridement therapy compare with conservative nonsurgical debridement of pressure ulcers?
Method: Over 5 years, researchers studied 103 patients with 143 pressure ulcers who received either maggot or conventional therapy for treatment of their wounds. The study was prospective but nonblinded and not randomized.
Results: Eighty percent of maggot-treated wounds were completely debrided compared with 48% of the conventionally treated ones. Wounds treated with maggots at some point in therapy took eight weeks to completely debride while a wound treated only with more conventional methods took 17 weeks.
Conclusion: Maggot therapy was more effective and efficient in treating chronic pressure ulcers than more conventional treatments.

Source: "Maggot versus conservative debridement therapy for the treatment of pressure ulcers," Wound Repair and Regeneration, July

Weblink

Abstract, "Maggot versus conservative debridement therapy for the treatment of pressure ulcers," Wound Repair and Regeneration, July (volume 10, issue 4)

Article, "Biosurgical Debridement Facilitates Healing of Chronic Skin Ulcers," Archives of Internal Medicine, Sept. 9 (volume 162, issue 16) (http://archinte.ama-assn.org/issues/v162n16/rfull/ibr20011-1.html)

HEALTH & SCIENCE