Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis

Objective: To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs). Method: A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane Library, EM base, EBSCOhost, Springer Link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. The literature was screened, the data were extracted and the methodological quality of the included studies was assessed. Meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage. Results: Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. The results of meta-analyses suggested that the MDT group was significantly superior to the control group in the percentage of DFUs to achieve full healing (RR=1.8, 95% CI=1.07; 3.02; p=0.03), amputation rate (RR=0.41, 95% CI=0.20; 0.85; p=0.02), time to healing (RR=-3.70, 95% CI=-5.76; -1.64; p=0.0004) and number of antibiotic-free days (126.8 +/- 30.3 days vs 81.9 +/- 42.1 days; p=0.001); however, collated differences in incidence of infection after intervention revealed no evidence of a difference between the MDT and control groups (RR=0.82, 95% CI=0.65; 1.04, p=0.10). Conclusion: Although MDT may be a scientific and effective therapy in treatment of DFUs, the evidence is too weak to routinely recommend it for treatment. Large studies and sample sizes are needed to assess the efficacy and safety of MDT in the treatment of DFUs.