Medication Summary
Although the common approach for either furuncular or wound myiasis is occlusion/suffocation techniques that have been mentioned above or surgical debridement and irrigation, oral ivermectin has been proven especially helpful with oral, orbital, and nasal involvement. [1] Ivermectin has decreased the associated inflammation and the destructive process prior to debridement. [21] Thus, it has been suggested that oral ivermectin should be considered as an option for treatment of human cavitary myiasis. [22] A case has been reported of facial furuncular myiasis in a HIV-infected patient who was treated with applications of topical solution that killed the larvae and facilitated their extraction. [23]
Anthelmintics
Class Summary
Neoadjuvant ivermectin therapy prior to surgical debridement has been recommended to prevent enucleation in patients with massive orbital involvement or to avoid the difficulties associated with mechanical removal of the larvae.
Ivermectin (Mectizan, Stromectol)
Ivermectin binds selectively with glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing cell death. Its half-life is 16 hours; it is metabolized in the liver.
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Mature larva of the Dermatobia hominis fly; rows of hooks apparent on its tapered body. Image courtesy of Kenneth E Greer.
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Boil-like lesion on toe of a patient with botfly myiasis; the central punctum is apparent. Image courtesy of Kenneth E Greer.
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Boil-like lesions on a patient with botfly myiasis; the central punctum is apparent. Image courtesy of Kenneth E Greer.
