K. PROPHYLAXIS

PROPHYLAXIS

There is a general consensus that antibiotic prophylaxis for the Aeromonas bacteria, which are symbionts of leeches and which could lead to complications, should be initiated before leech therapy [18,36]. Aeromonas species are sensitive to second- and third-generation cephalosporins, fluoroquinolones, sulfamethoxazole-trimethoprim, tetracycline, and aminoglycosides, while Aeromonas is resistant to penicillin, ampicillin, first-generation cephalosporins, and erythromycin [32,37,38]. Patients should be treated each day of leech therapy with anti-Aeromonas antibiotics such as 500 mg of ciprofloxacin [18,35]. However, out of 21 isolates of Aeromonas species isolated from the water collected from the leech tanks, 71.4% were ciprofloxacin susceptible. All isolates were sulfamethoxazole-trimethoprim susceptible, which was also used as a prophylactic antibiotic regimen of choice for leech therapy [39]. A regular surveillance to detect resistant Aeromonas species in medical leeches, by controlling the water in which they are kept, was suggested. Chepeha et al. [40] used an antibiotic prophylaxis with double coverage during leech application and single coverage for 2 weeks after leech therapy is discontinued. In the Iowa Head and Neck Protocol [41], Levaquin is administered before the first leech is applied to the skin and continued until 24 hours after leech therapy is discontinued.