Prophylaxis for medicinal leech therapy
Medicinal leech therapy (hirudotherapy) is most commonly used following plastic or reconstructive surgery. Wound infection complicates medicinal leech therapy in approximately 14% of cases, with the severity ranging from mild to severe with associated sepsis. Aeromonas species live symbiotically in the digestive tract of leeches and are the most commonly identified pathogens from wound infections complicating medicinal leech therapy.
Antibiotic prophylaxis reduces the risk of infection from medicinal leech therapy; however, there is limited clinical evidence to determine the optimal antibiotic regimen. Antimicrobial resistance has been identified in Aeromonas species isolated from medicinal leeches, the tank water used to house medicinal leeches, and patients who developed infection after medicinal leech therapy. Therefore, regular testing of tank water to identify pathogens (by culture and susceptibility testing) as well as consideration of local epidemiology assists in determining the most appropriate antibiotic for prophylaxis.
A reasonable regimen for antibiotic prophylaxis for medicinal leech therapy is:
trimethoprim+sulfamethoxazole 160+800 mg (child 1 month or over: 4+20 mg/kg up to 160+800 mg) orally, immediately before starting medicinal leech therapy, then 12-hourly for the duration of leech therapy and for 24 hours after stopping leech therapy. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. medicinal leech therapy, prophylaxis trimethoprim + sulfamethoxazole
For patients with hypersensitivity to trimethoprim+sulfamethoxazole (for adults, see Overview of trimethoprim+sulfamethoxazole hypersensitivity in adults; for children, seek expert advice), or if local susceptibility data indicates high rates of trimethoprim+sulfamethoxazole resistance in Aeromonas, use:
ciprofloxacin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, immediately before starting medicinal leech therapy, then 12-hourly for the duration of leech therapy and for 24 hours after stopping leech therapy1 2. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. ciprofloxacin
Do not use quinolones for first-line prophylaxis because their use is associated with the development of resistance.
For management of established infection associated with medicinal leech therapy, see here.