American Society of Hirudotherapy

Rethinking antimicrobial prophylaxis in patients receiving medicinal leech therapy

Case report published in American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (2022)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Case reportSafety & Infection ControlClinical TrialsGenomics & ProteomicsMcCracken J, Koehler S, Sharma R · American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2022

Abstract

PURPOSE: To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of leeches. SUMMARY: This article presents a patient case of reconstructive surgery complicated by infection associated with the use of medicinal leeches, as well as a discussion of prophylaxis in medicinal leech therapy, focusing on considerations for choosing a prophylactic agent. CONCLUSION: Our case report highlights resistance changes in Aeromonas isolates associated with medicinal leeches and the potential for complications if isolates resistant to chosen prophylactic agents arise. When administering antimicrobial prophylaxis in patients receiving medicinal leech therapy, clinicians should be familiar with the susceptibilities of Aeromonas species but also conscious of evolving antimicrobial resistance given the extent of the consequences of infected surgical grafts.

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

Publication typeCase ReportsJournal Article
Indexed MeSH termsAnimalsAnti-Bacterial AgentsEthnicityHumansLeechesLeeching

Summary

To describe challenges in the management of prophylaxis against infections for patients receiving medicinal leech therapy given changes in antimicrobial resistance patterns in the normal flora of leeches.

Why This Matters for Hirudotherapy

This case report examines the clinical challenges of antimicrobial prophylaxis in patients receiving medicinal leech therapy, specifically detailing a reconstructive surgery case complicated by an infection associated with leech use. Because hirudotherapy relies on the application of live leeches, understanding the evolving antimicrobial resistance patterns in the normal flora of these leeches—particularly Aeromonas species—is critical for preventing severe surgical graft infections and ensuring patient safety. The report highlights the need for clinicians to stay informed about local resistance susceptibilities when choosing prophylactic agents. However, as the insights are derived from a single patient case report, the findings are limited in scope and lack broader quantitative outcome data, meaning the proposed prophylaxis strategies require further clinical validation.

Citation

Rethinking antimicrobial prophylaxis in patients receiving medicinal leech therapy.

McCracken J, Koehler S, Sharma R · American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2022

DOI

Added to ASH library: March 18, 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.