Can laboratory investigations help us to decide when to discontinue larval therapy?

OBJECTIVE This study investigated retrospectively whether three laboratory investigations--testing for leucocyte levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)--can be used to guide the decision of when to discontinue larval therapy. METHOD Between 1999 and 2002 we administered larval therapy to 16 inpatients. In all cases the decision to discontinue therapy was a clinical one made by the surgeon who headed the trauma department. We retrospectively analysed laboratory investigations, testing for leucocyte levels, CRP and ESR, on the first and last days of therapy to ascertain if the results could have guided this decision. RESULTS The median leucocyte count on the first day of larval therapy was 10.5 (x 10e9/L) compared with 8.4 (x 10e9/L) on the last day (Friedman test: p < 0.05). CRP and ESR showed a non-significant tendency towards lower values. CONCLUSION Although the methodological limitations of this open-label non-comparative cohort study preclude a definite conclusion, we believe that laboratory investigations, particularly leucocyte count, can guide the decision of when to discontinue larval therapy. However, this objective parameter cannot replace clinical judgement.