By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Although the standard treatment for infected wounds continues to include antimicrobial therapy, other therapies are gaining in popularity due to the rise in antibiotic resistance. This month's blog will explore some of these alternative therapies.

Leeches
In the 19th century, physicians routinely used leeches in everyday treatment for a wide variety of ailments. However, rapid advances in medicine saw leech use fall by the wayside. Today, although leeches are rarely used, leech therapy has a place in the treatment of a specific population of patients - those who have venous congestion following transplantation or reattachment surgery. Leeches are useful in treating patients with venous-compromised tissue because their saliva is rich in:

• hyaluronidase, which has antibiotic properties and also assists in spreading the leech saliva through the affected wound tissue
• histamine-like vasodilator, which encourages local bleeding
• hirudin, a thrombin inhibitor
• local anesthetic properties, which can help in pain control

Thus, leeches may be used in patients with venous issues who also have infection. One drawback to the use of leeches is the high incidence of Aeromonas hydrophila infection, which may affect as many as 20% of patients. Prophylactic antibiotics reduce this risk. Leeches were cleared for use by the FDA in 2004, around the same time as maggots received approval.

Maggots
If the idea of handling leeches or applying them to a patient's wound makes you squeamish, you might find maggots more acceptable. After all, they only consume "dead" tissue…

Maggot therapy has also been around for a long time, going all the way back to the Napoleonic war. Battle surgeons noted that patients whose wounds became infested with maggots healed better and more quickly. When antibiotics came on the scene in World War 2, maggot therapy faded into obscurity. Today, however, maggots are enjoying resurgence in popularity.

Medicinal maggots are "raised" in a sterile environment and do not feed or reproduce on live tissue. What do maggots do? They feed on bacteria, digesting the bacteria in their gastrointestinal tract. They also secrete a substance which helps to dissolve necrotic tissue, disinfects the wound and acts as a stimulant for wound healing. Maggot therapy is cost-effective in comparison to other wound treatments. Best of all, maggot therapy is also effective in treating infections caused by resistant organisms, such as MRSA.

Honey
Don't let the title of this article frighten you - bees are not used in wound treatment; rather, the fruit of their labor is used. Honey is an ancient wound therapy dating back centuries. Today, honey is again becoming more popular in treating wounds (particularly infected wounds), due to the following properties:

• honey acts as a sealant, keeping the wound bed moist and free of any contamination
• honey has a high sugar content and also contains amino acids, vitamins and minerals that aid in healing and tissue growth
• honey is hyperosmotic, killing microorganisms that cannot survive in such an environment
• honey contains the enzyme glucose oxidase, which leads to the production of hydrogen peroxide when exposed to oxygen in the air
• honey promotes autolytic debridement

Manuka is a medicinal honey that has enhanced antimicrobial properties and has been approved for use in the US since 2007. Numerous studies support the use of medicinal honey in the treatment of infected wounds.

These are just a few alternative options to the use of antibiotics for the treatment of wound infections. Due to the increase in antibiotic-resistant organisms, research is focusing more and more on alternative therapies.

Sources
Dente K. Alternative treatments for wounds: leeches, maggots, and bees. Medscape. http://www.medscape.com/viewarticle/563656. 2007. Accessed May 16th, 2013.

Simon A, Traynor K, Santos K, Blaser G, Bode U, Molan P. Medical honey for wound care- still the latest resort? Evid Based Complement Alternat Med. 2009;6(2):165–173.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.