What is the treatment for Babesiosis (infection caused by Babesia, a genus of protozoal parasites)?

From the Guidelines

The combination of atovaquone plus azithromycin or clindamycin plus quinine for 7–10 days is the initial therapy that should be considered for patients with babesiosis. When considering treatment for babesia, it is essential to prioritize the most effective and evidence-based approach to minimize morbidity, mortality, and improve quality of life. According to the clinical practice guidelines by the Infectious Diseases Society of America 1, the recommended dosage regimen of atovaquone plus azithromycin for adults is atovaquone, 750 mg orally every 12 h, and azithromycin, 500–1000 mg on day 1 and 250 mg once per day thereafter by the oral route. Some key points to consider when treating babesia include:

• The dosage regimen of clindamycin plus quinine for adults is clindamycin, 300–600 mg every 6 h intravenously or 600 mg every 8 h orally, and quinine, 650 mg every 6–8 h orally, as outlined in the guidelines 1.
• For immunocompromised patients with babesiosis, higher doses of azithromycin (600–1000 mg per day) may be used, as suggested by the guidelines 1.
• Exchange transfusion should be considered for patients with severe babesiosis, particularly those with high parasitemia or significant organ dysfunction, as recommended by the guidelines 1.
• Supportive care, including hydration and monitoring for complications, is essential for patients with babesiosis, as the disease can be life-threatening, especially in immunocompromised patients, the elderly, or those without a spleen. The guidelines emphasize the importance of prompt treatment upon diagnosis, as babesiosis can be life-threatening 1. Follow-up blood smears are recommended to confirm clearance of parasitemia after treatment completion, ensuring the effectiveness of the treatment approach.

From the Research

Treatment Options for Babesia

• The current treatment for babesiosis typically involves a 7-10-day course of azithromycin plus atovaquone or clindamycin plus quinine 2, 3, 4, 5.
• Azithromycin and atovaquone have been found to be equally effective in treating adults with babesiosis, with fewer adverse reactions compared to clindamycin and quinine 3, 5.
• Exchange transfusion is a potentially life-saving therapy for patients with severe disease, high parasitemia, significant hemolysis, or renal or pulmonary compromise 3.

Considerations for Immunocompromised Patients

• Highly immunocompromised patients may respond suboptimally to standard drug regimens and are at risk of developing resistance to azithromycin-atovaquone 2.
• Reducing the level of immunosuppression when possible may be a desirable strategy for managing babesiosis in immunocompromised patients 2.
• Prolonged treatment may be necessary for severe disease in immunocompromised individuals 4.

Emerging Concerns and Future Directions

• The emergence of drug resistance in Babesia microti is a concern, particularly in highly immunocompromised patients 2, 6.
• There is a need for new therapeutic strategies that are specifically tailored to Babesia parasites, as current treatments were repurposed from other apicomplexan parasites 6.