Leptospirosis—clinical review and updates on therapeutics

Leptospirosis is a globally distributed zoonotic bacterial disease caused by Leptospira spp. Mortality and morbidity burdens are greatest in low-to-middle-income tropical countries, where frequent natural disasters and poor infrastructure drive outbreaks that disproportionately affect marginalised communities. Leptospirosis is a common but overlooked cause of acute undifferentiated fever. This neglect is augmented by limited diagnostics, insufficient treatment evidence, and the absence of a coordinated global health policy. Diagnosis requires clinical vigilance and timely testing, although access to and accuracy of available diagnostics is limited. Antimicrobial therapy recommendations are conditional based on clinical context. Monitoring for organ-specific complications and early organ supportive care is essential. Supporting evidence for current treatment practices remains weak, undermined by methodological inconsistency and low funding. This state-of-the-art Review of leptospirosis clinical management is aimed at clinicians in general medicine, infectious diseases, and public health. Existing treatment evidence gaps are comprehensively summarised to inform future research and therapeutic strategies.