netFormulary NHS
Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
 Formulary Chapter 26: A5 - Wound management products and elasticated garments - Full Chapter

 Please note: silk garments are non-formulary

Chapter Links...
A5.10  Expand sub section  Larvae

View adult BNF View SPC online View childrens BNF
Formulary Consider standard dressings first 
(free range or in BioFOAM dressing)
View adult BNF View SPC online View childrens BNF
Amber Recommended

Free range: Biomonde Larvae 100/200 or BioBag
Biosurgical treatment for the debridement and cleansing of wounds consisting of aseptically produced living larvae.
The BioBag is presented in the five (5) configurations listed below. The larvae are Lucilia sericata contained in a sterile polyester net bag with a sterile PVA spacer cube, presented in a sterile transport container.
BioBag 50 at least 50 larvae 25 x 40mm 1 8x8x10
BioBag 100 at least 100 larvae 50 x 40mm 1 12x12x10
BioBag 200 at least 200 larvae 60 x 50mm 1 25x10x10
BioBag 300 at least 300 larvae 120 x 60mm 2 25x10x10
BioBag 400 at least 400 larvae 100 x 100mm 2 25x10x10
Free range larvae, larvae and 30 x 30 flat retention net plus kit pack, larvae and 40 x
60cm boot retention net plus kit pack. Additional 100 or 200 larvae available.
Type of wound product is suitable for
The BioMonde Larval Debridement Therapy Products are indicated for debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post-surgical wounds.
Duration dressing remains on wound before changing and frequency of dressing change
An application of BioBag can be left in place for up to 4 days, dependent on the
condition of the wound. If the wound is not sufficiently debrided after 4 days, the treatment can be repeated with a fresh application of BioBag. The treatment should be stopped as soon as the wound is sufficiently debrided or if no improvement is observed after 3 or more applications. The total number of treatment cycles will depend on the characteristics of the wound, the response of the patient to LDT and the aim of the therapy. Most ulcers are completely debrided within 1 to 6 treatment cycles. If exudate production is excessive, the secondary dressing may be changed as required while leaving the BioBag undisturbed. Frequent removal of the outer dressing will also help to control the odour associated with the liquefied necrotic tissue
Caution/contraindications (when not to use the dressing, patient groups to avoid etc.)
Larvae should not be used in patients with known hypersensitivities to fly larvae, polyester, PVA (polyvinyl alcohol) or the components of the media on which the larvae are raised (including soya protein, yeast protein, potato starch and bovine protein) as this may result in dermatitis or more severe immunological reactions in susceptible individuals. If treatment is undertaken then these patients should be under strict medical supervision for the duration of the treatment with immediate access to care. Patients with life or limb-threatening, rapidly advancing infections should not be
treated with as LDT may interfere with the close and frequent observation that these
patients require.
Should not be used as first line therapy of infected tendon and bone. These wounds
should be treated surgically and/or with antibiotics before using LDT.
Should not be used to treat wounds which are not directly exposed to the outside.
Wounds should never be allowed to close over the larvae either intentionally or unintentionally.
Should not be used on wounds with an inadequate blood supply as this ultimately reduces the ability of the wound to heal. LDT will enlarge the wound as necrotic tissue is debrided but the resulting clean wound is at risk from re-infection.
Although some mild bleeding is common during LDT, larvae should not be used on wounds that have a tendency to bleed or wounds close to an exposed major blood vessel, especially if considered to be necrotic as this can lead to rupture of the blood vessels which could be life-threatening. If LDT is attempted, the patient must remain under strict medical supervision for the duration of the treatment.
Should not be used on patients with an inborn or medication-induced coagulopathy or
in patients being treated with anticoagulants. If these patients are treated with LDT, they should remain under strict medical supervision for the duration of the treatment. Should never be used in sterile body cavities.
Should be used with caution on wounds over adjacent exposed organs or leading to a body cavity, and only under close medical supervision for the duration of the treatment. Data are not available concerning the antibiotic / antiseptic activity of maggots and therefore any infected wound should receive standard antibiotic care.
Rationale for inclusion in formulary
Only available larval therapy on prescription.
Rapid debridement of chronic wounds
Can be utilised in the community

note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Track Changes
Display tracking information
click to search
Link to adult BNF
click to search
Link to children's BNF
click to search
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHS England

Traffic Light Status Information

Status Description

Prescribing in children

The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.


Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.   

Amber Initiation

Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.  

Amber Recommended

Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.  

Amber SC

Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.  


Medicines for initiation and maintenance prescribing by Specialists only.  


Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.  


Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.  

The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.