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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/babesiosis.
Babesiosis
[Babesia divergens] [Babesia duncani] [Babesia microti] [Babesia MO-1]
Treatment Information
Most asymptomatic persons do not require treatment. Health care providers may consult CDC staff about whether to treat someone who has babesiosis, what type(s) of therapy to use, how to monitor the status of the infection, and how long to treat. Treatment decisions should be individualized, especially for patients who have (or are at risk for) severe or relapsing infection.
For ill patients, babesiosis usually is treated for at least 7-10 days with a combination of two prescription medications — typically either:
- atovaquone PLUS azithromycin; OR
- clindamycin PLUS quinine (this combination is the standard of care for severely ill patients).
The typical daily doses for adults are provided in the table below.
| Drug | Adult dosage (usually treat for at least 7-10 days) |
|---|---|
| Atovaquone | 750 mg orally twice a day |
| along with | |
| Azithromycin | On the first day, give a total dose in the range of 500-1000 mg orally; on subsequent days, give a total daily dose in the range of 250-1000 mg |
| or | |
| Clindamycin | 600 mg orally 3 times a day or 300-600 mg intravenously 4 times a day |
| along with | |
| Quinine | 650 mg orally 3 times a day |
Some patients—including those with severe illness—might require or benefit from supportive care, such as:
- antipyretics;
- vasopressors (if the blood pressure is low and unstable);
- blood transfusions;
- exchange transfusions (in which portions of a patient’s blood or blood cells are replaced with transfused blood components);
- mechanical ventilation; or
- dialysis
Atovaquone
Atovaquone is available for human use in the United States.
Note on Treatment in Pregnancy
Atovaquone is in pregnancy category C. Data on the use of atovaquone in pregnant women are limited, and the risk to the embryo-fetus is unknown. Because data are available about safe administration of quinine plus clindamycin during pregnancy, this drug combination, rather than atovaquone (plus azithromycin), generally is recommended for treatment of symptomatic babesiosis during pregnancy, unless the preferred medications are not available or tolerated.
Pregnancy Category C: Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal, or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.
Note on Treatment During Lactation
It is not known whether atovaquone is excreted in breast milk. Atovaquone should be used with caution in women breastfeeding infants who weigh <5 kg.
Note on Treatment in Pediatric Patients
Atovaquone has been used safely in children who weigh ≥ 5 kg.
Azithromycin
Azithromycin is available for human use in the United States.
Note on Treatment in Pregnancy
Azithromycin is in pregnancy category B. Data on the use of azithromycin in pregnant women are limited. Azithromycin may be used during pregnancy in those patients who will clearly benefit from the drug.
Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).
Note on Treatment During Lactation
According to a case report, azithromycin was excreted in breast milk and the nursing infant did not have adverse effects. Azithromycin should be used with caution in breastfeeding women, although the risk to the exposed infant probably is low.
Note on Treatment in Pediatric Patients
In controlled clinical trials for various bacterial infections, oral azithromycin has been safely administered to pediatric patients aged 6 months to 16 years. Anecdotal cases of babesiosis in children, including infants, have been safely treated with azithromycin plus atovaquone.
Clindamycin
Clindamycin is available for human use in the United States.
Note on Treatment in Pregnancy
Clindamycin is in pregnancy category B. Data on the use of clindamycin in pregnant women are limited, although no congenital anomalies have been reported. Clindamycin may be used during pregnancy in those patients who will clearly benefit from the drug.
Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).
Note on Treatment During Lactation
Clindamycin is excreted in breast milk. The American Academy of Pediatrics classifies clindamycin as usually compatible with breastfeeding.
Note on Treatment in Pediatric Patients
The parenteral form of clindamycin contains benzyl alcohol, which has been associated with a fatal "gasping syndrome" in premature infants.
This information is provided as an informational resource for licensed health care providers as guidance only. It is not intended as a substitute for professional judgment.
