How do you treat a maggot infestation?

Treatment of Maggot Infestation in Wounds

The most effective approach to treat a maggot infestation is thorough debridement to remove all visible maggots, followed by proper wound care based on the wound characteristics. 1

Initial Management

Maggot Removal

• Perform thorough sharp debridement to remove all visible maggots and necrotic tissue 1
• For extensive infestations, consider using Yankauer suction for efficient removal of larvae 2
• Irrigate the wound thoroughly with saline solution after maggot removal 1
• Examine deeper tissues to assess the extent of damage and potential infection 1

Wound Assessment

• Evaluate for signs of infection (erythema, warmth, purulence, odor) 1
• Obtain tissue specimens from the base of the debrided wound for culture before starting antibiotics 1
• Assess vascular status of the affected area to determine if revascularization is needed 1
• Trim surrounding hyperkeratotic tissue (callus) if present 1

Wound Care After Maggot Removal

Dressing Selection

• For exudative wounds: Use alginate or foam dressings 1
• For dry/necrotic wounds: Use continuously moistened saline gauze or hydrogels 1
• For wounds requiring autolysis: Use hydrocolloid dressings 1
• Change dressings at least daily to allow for wound examination 1

Antibiotic Therapy

• For clinically infected wounds:
  • Mild infections: Oral antibiotics (dicloxacillin, clindamycin, cefalexin, or amoxicillin-clavulanate) 1
  • Moderate to severe infections: Initial parenteral broad-spectrum antibiotics (piperacillin/tazobactam with vancomycin if MRSA is suspected) 1
• Do not use antibiotics for clinically uninfected wounds 1
• Adjust therapy based on culture results within 2-3 days 1

Pressure Relief

• Remove pressure from the wound to promote healing 1
• Consider appropriate offloading devices based on wound location 1
• Avoid total contact casts for infected wounds as they limit wound visualization 1

Follow-up Care

• Assess inpatients daily and outpatients every 2-5 days initially 1
• Look for resolution of local and systemic symptoms, reduction in inflammation, and development of healthy granulation tissue 1
• Continue antibiotics until resolution of infection signs, but not through complete wound healing 1
• Typical duration: 1-2 weeks for mild infections and 2-3 weeks for moderate to severe infections 1

Special Considerations

Therapeutic Maggot Debridement Therapy (MDT)

• It's important to distinguish between wild maggot infestation (which requires removal) and therapeutic maggot therapy 1
• For wounds with extensive necrotic tissue that is difficult to debride conventionally, consider therapeutic MDT using sterile Lucilia sericata larvae 1, 3
• Therapeutic maggots separate necrotic tissue from living tissue, making surgical debridement easier 3
• In 80-95% of cases, complete or significant debridement is achieved with therapeutic MDT 3

Common Pitfalls to Avoid

• Inadequate debridement of necrotic tissue 1
• Failure to properly offload pressure from the wound 1
• Inappropriate use of antibiotics for non-infected wounds 1
• Neglecting to assess vascular status 1
• Confusing therapeutic maggots with wild maggot infestation 1
• Delaying debridement while awaiting revascularization 1

By following this systematic approach, you can effectively treat maggot infestations while promoting optimal wound healing and preventing complications.