» Patients may experience increased pain
and/or exudate, which may appear
bloody but is harmless;
» Maggots are contraindicated for use
near the eyes, upper gastrointestinal
tract and upper respiratory tract, and
in patients who have a reported allergy
to fly larvae, brewer’s yeast or soya
bean protein;
» Larval therapy is not suitable for:
wounds with exposed blood vessels
potentially connecting to deep vital
organs, in patients with decreased
perfusion, or in malignant wounds;
» Care should be taken in patients known
to be at risk of bleeding, such as those
receiving warfarin or heparin or those
with a bleeding disorder, as maggots
can, in rare cases, cause bleeding. If
maggots are used in this patient group,
the wound must be monitored carefully
for excessive bleeding;
» It may be necessary to use antibiotics in
conjunction with larval therapy,
particularly if a Pseudomonas aeruginosa
infection is present;
» Wounds must not be allowed to close
over larvae;
» Larvae may drown in copious exudate appropriate dressings are required to
enable them to breathe;
» There is a “yuck factor” for many
patients and health professionals.
Sterile maggots are available on FP10
prescription for use in the community.
They are an expensive method of debridement,
costing £58 per application loose
and £99 in bagged form (UK prices in 2011).
Information and specialist training is
available to ensure practitioners are competent
and proficient at administering
larval therapy.