Babesiosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

The mainstay of therapy for babesiosis is antimicrobial therapy. Patients with mild or moderate disease are treated with a combination of Atovaquone and Azithromycin. Patients with severe disease are treated with either Clindamycin or Clindamycin and Quinine. In life-threatening cases, exchange transfusion is performed.

Medical Therapy

The traditional regimen of Quinine and Clindamycin is often poorly tolerated; recent evidence suggests that a regimen of Atovaquone and Azithromycin can be equally effective [1]. In life-threatening cases, exchange transfusion is performed. In this procedure, the infected red blood cells are removed and replaced with fresh ones.

Antimicrobial Regimen

  • Treatment
  • 2. Severe disease:
  • Preferred regimen: Clindamycin 600 mg PO tid AND Quinine 650 mg PO tid for 7–10 days
  • Preferred regimen: Clindamycin 1.2 g IV q12h
  • Note (1): For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks.
  • Note (2): Consider transfusion if 􀂕10% parasitemia.

References

  1. Krause P, Lepore T, Sikand V, Gadbaw J, Burke G, Telford S, Brassard P, Pearl D, Azlanzadeh J, Christianson D, McGrath D, Spielman A (2000). "Atovaquone and azithromycin for the treatment of babesiosis". N Engl J Med. 343 (20): 1454–8. PMID 11078770.
  2. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.