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.

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.

• Treatment

• 1. Mild/moderate disease^[2]
• Preferred regimen: Atovaquone 750 mg PO bid AND Azithromycin 600 mg PO qd for 7-10 days

• 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.