SAFE AND EFFECTIVE THERAPEUTIC USE OF INVERTEBRATES

To recognize use of medical invertebrates (e.g., maggots and leeches) as an alternative treatment in limited clinical circumstances; further,

To educate pharmacists, other providers, patients, and the public about the risks and benefits of medical invertebrates use and about best practices for use; further,

To advocate that pharmacy departments, in cooperation with other departments, provide oversight of medical invertebrates to assure appropriate formulary consideration and safe procurement, storage, use, and disposal; further,

To encourage independent research and reporting on the therapeutic use of medical invertebrates.

Rationale

Medical invertebrates, including leeches and maggots, are used as a therapeutic intervention for various indications, including in treatment of extravasation injury, post-plastic-surgery salvage, relief of vascular congestion, macroglossia, compartment syndrome, pain management, and debridement therapy. The use of medical invertebrates is not without risk. There have been reports of local and systemic infections with use of leeches and transmission of communicable disease if not handled properly, and use may mask coagulopathies. Antimicrobial prophylaxis may be required, and there are also drug-invertebrate interactions that may impact the effectiveness of invertebrate therapy. There is also limited research on the efficacy of these therapies that lead to varied practice and unsubstantiated claims. In addition, leeches may present a biohazard. Application or manipulation may require expulsion of blood to encourage reattachment, and there have been cases in which engorged leeches have fallen off patients, potentially exposing caregivers and other patients to blood.

To promote safe use of medical invertebrates, pharmacy departments, in cooperation with other health-system departments, should assure appropriate formulary consideration and safe procurement, storage, use (e.g., control, prescribing, preparation, dispensing, administration, application, manipulation, documentation, consideration for antimicrobial prophylaxis, clinical and regulatory monitoring), and disposal.