American Society of Hirudotherapy

Preventing infective complications following leech therapy: is practice keeping pace with current research?

Survey study published in Microsurgery (2009)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Research reportSafety & Infection ControlWhitaker IS, Kamya C, Azzopardi EA, Graf J, Kon M, Lineaweaver WC · Microsurgery, 2009

Abstract

BACKGROUND: Despite several publications strongly advocating prophylactic antibiotics during leech therapy, and recent primary articles shedding new light on the microbiota of leeches, many units either do not use antibiotic prophylaxis, or are continuing to use ineffective agents. METHODS: A 5-year follow-up of plastic surgery units in the United Kingdom and the Republic of Ireland was conducted in 2007 to ascertain current practice regarding the use of prophylactic antibiotics with leech therapy. A comprehensive literature search investigated primary research articles regarding the microbiota of leeches to update the reconstructive surgery community. RESULTS: Despite published evidence to support the use of prophylactic antibiotics during leech therapy, 24% of units do not use antibiotic prophylaxis and 57% of those using antibiotics are using potentially ineffective agents. Advanced molecular genetic techniques, which allow accurate characterization of both culturable and non-culturable microbiota of the leech digestive tract, show a wider diversity than at first thought, with variable antibiotic resistance profiles. CONCLUSIONS: Despite infection due to leech therapy being a well known and relatively common complication, many units are not using appropriate antibiotic prophylaxis.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleResearch Support, U.S. Gov't, Non-P.H.S.
Indexed MeSH termsAeromonasAnimalsAntibiotic ProphylaxisGram-Negative Bacterial InfectionsHumansIrelandLeechesLeechingPlastic Surgery ProceduresUnited Kingdom

Summary

A 2007 follow-up survey of plastic surgery units in the United Kingdom and Ireland found that roughly a quarter still skip antibiotic prophylaxis during leech therapy, and over half of those who prescribe it choose agents likely to be ineffective.

Why This Matters for Hirudotherapy

This study reports a five-year follow-up conducted in 2007 of plastic surgery units in the United Kingdom and the Republic of Ireland regarding prophylactic antibiotic use during leech therapy, combined with a literature search on the microbiota of leeches. The survey found that 24% of units do not use antibiotic prophylaxis and 57% of those using antibiotics are using potentially ineffective agents. The literature search, noting that advanced molecular genetic techniques reveal greater microbial diversity in the leech digestive tract than previously appreciated, found variable antibiotic resistance profiles. The authors conclude that many units are not using appropriate antibiotic prophylaxis despite well-known infection risks associated with leech therapy. These findings are relevant to hirudotherapy practice, documenting the gap between published evidence on prophylaxis and actual clinical practice in these regions.

Citation

Reference (Vancouver style)

Whitaker IS, Kamya C, Azzopardi EA, Graf J, Kon M, Lineaweaver WC. Preventing infective complications following leech therapy: is practice keeping pace with current research? Microsurgery. 2009;29(8):619-625. doi:10.1002/micr.20666. PMID: 19399888

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

Added to ASH library: May 26, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.