From the Guidelines
The recommended medication regimen for babesiosis is a combination of atovaquone (750 mg orally twice daily) plus azithromycin (500-1000 mg on day 1, followed by 250-500 mg daily) for 7-10 days, as this regimen has been shown to be more effective and better tolerated than alternative treatments 1. This regimen is recommended for initial therapy in patients with babesiosis, with the option to extend treatment duration in immunocompromised patients or those with persistent symptoms.
- The combination of atovaquone and azithromycin targets different aspects of the parasite's lifecycle, making it a more effective approach than monotherapy.
- For severe cases, an alternative regimen is clindamycin (600 mg orally or 300-600 mg IV every 6 hours) plus quinine (650 mg orally every 6-8 hours) for 7-10 days, which may be considered for patients with severe babesiosis 1.
- Treatment should begin promptly upon diagnosis, as Babesia microti and other Babesia species can cause progressive illness with potential complications including hemolytic anemia, thrombocytopenia, and organ failure if left untreated.
- The dosage regimen for atovaquone plus azithromycin in children is atovaquone, 20 mg/kg every 12 h (up to a maximum of 750 mg per dose), and azithromycin, 10 mg/kg per day once per day on day 1 (up to a maximum of 500 mg per dose) and 5 mg/kg once per day thereafter orally 1.
- For immunocompromised patients with babesiosis, higher doses of azithromycin (600–1000 mg per day) may be used in combination with atovaquone, as this has been reported to be successful in achieving a favorable outcome 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Regimen for Babesia
The current treatment recommendations for babesiosis include:
Efficacy of Treatment Regimens
Studies have shown that atovaquone and azithromycin are as effective as clindamycin and quinine in treating babesiosis, with fewer adverse reactions 4. However, there have been reports of treatment failures and resistance to atovaquone and azithromycin 6.
Adverse Reactions
Common adverse reactions to atovaquone and azithromycin include diarrhea and rash 4, while clindamycin and quinine are associated with tinnitus, diarrhea, and decreased hearing 4.
Special Considerations
Immunocompromised individuals may require prolonged treatment for babesiosis 2, and there is a need for new therapeutic strategies that are specifically tailored to Babesia parasites 3.