Patel Bhavna C, Ostwal Shrenik, Sanghavi Priti R, Joshi Geeta, Singh Richa
Department of Palliative Medicine, Gujarat Cancer and Research Institute, Ahmadabad, Gujarat, India.
Community Oncology Center, Ahmadabad, Gujarat, India.
Indian J Palliat Care. 2018 Oct-Dec;24(4):459-464. doi: 10.4103/IJPC.IJPC_112_18.
Myiasis, tissue infestation by housefly larvae, is commonly found in malignant fungating wounds of cancer patients from climatic condition and lower socio-economic strata.
It was aimed to study the effectiveness of systemic Ivermectin, Albendazole& Clindamycin (Triple Therapy) in reducing signs & symptoms associated with maggots in malignant head and neck wounds.
25 adult, advanced head and neck cancer patients presenting with maggots either from wound, oral cavity or nostril, with ECOG score 3 or less were enrolled in this study. Symptoms were assessed using Edmonton Symptom Assessment Scale (ESAS) and wound by Wound Assessment Tool - Hospice, at baseline and then Days 1, 3, 5, and 7. All patients received 3 days course of oral Ivermectin 12 mg per day, Albendazole 400 mg twice per day and Clindamycin 300 mg three times per day for 5 days along with Terpentine oil dressing. All patients received oral Morphine as per their pain score.
Mean age (yrs) and weight (Kg) were 42.15 ± 8.23 and 52.31 ± 5.18 respectively. 84% patients were male. Mean oral morphine dose was 100.38 mg. There was significant decrease in number of maggots from day 0 (77.28 ± 13.465) to day 1 (20.60 ± 7.263; 73.34% reduction) to day 3 (1.52 ± 2.104; 92.62% reduction). We found statistically significant improvement ( = <0.05) in scores of wound and all other related symptoms on days 1, 3, 5 & 7, except bleeding, edema, nausea, anxiety, appetite loss and feeling of wellbeing, which remained same on Day 1, but improved afterward. Side effects were self-limiting.
Systemic treatment with Ivermectin, Albendazole and Clindamycin (Triple Therapy) enhances the removal of maggots, early recovery and relief from distress and associated symptoms.
蝇蛆病是由家蝇幼虫引起的组织感染，常见于气候条件较差和社会经济地位较低的癌症患者的恶性溃疡伤口中。
旨在研究全身性伊维菌素、阿苯达唑和克林霉素（三联疗法）在减轻恶性头颈部伤口蛆虫相关体征和症状方面的有效性。
本研究纳入了25例成年晚期头颈部癌症患者，这些患者的伤口、口腔或鼻孔中有蛆虫，东部肿瘤协作组（ECOG）评分≤3。在基线以及第1、3、5和7天，使用埃德蒙顿症状评估量表（ESAS）评估症状，并使用临终关怀伤口评估工具评估伤口。所有患者接受为期3天的口服伊维菌素治疗，每天12毫克，阿苯达唑每天400毫克，分两次服用，克林霉素每天300毫克，分三次服用，持续5天，并配合松节油敷料。所有患者根据疼痛评分服用口服吗啡。
平均年龄（岁）和体重（千克）分别为42.15±8.23和52.31±5.18。84%的患者为男性。平均口服吗啡剂量为100.38毫克。蛆虫数量从第0天（77.28±13.465）显著减少至第1天（20.60±7.263；减少73.34%），再到第3天（1.52±2.104；减少92.62%）。我们发现，在第1、3、5和第7天，伤口及所有其他相关症状的评分有统计学意义的改善（P<0.05），除出血、水肿、恶心、焦虑、食欲减退和幸福感外，这些症状在第1天保持不变，但随后有所改善。副作用为自限性。
伊维菌素、阿苯达唑和克林霉素的全身治疗（三联疗法）可促进蛆虫清除、早期康复并缓解痛苦及相关症状。
