Babesia combination therapy is essential because doxycycline — the go-to antibiotic for most tick-borne illnesses — doesn’t work against Babesia. This parasite requires a different approach, often involving multiple medications.
In a recent article published in The Nurse Practitioner, Paparone discusses the various presentations of Babesia, along with treatment plans for five individuals.
Babesia Combination Therapy: Two Main Options
The patients were treated with either:
- Atovaquone suspension (750 mg orally twice daily) and azithromycin (250 to 500 mg daily), or
- Oral clindamycin (600 mg every 8 hours) and oral quinine (650 mg three times daily)
One individual with a history of hairy cell leukemia, splenectomy, permanent pacemaker insertion for atrioventricular block, gouty arthritis, prostatic hypertrophy, and polymyalgia rheumatica underwent exchange transfusion.
Side Effects of Babesia Combination Therapy
Side effects occurred in two out of the five patients.
In one case, quinine was switched to atovaquone suspension and azithromycin due to acute hearing deterioration.
In the second case, clindamycin and quinine were stopped due to gastric distress and a generalized erythematous rash.
Four of the five cases were treated with doxycycline concurrently for the possibility of anaplasmosis.
Why First-Line Combination Therapy Matters
As these cases highlight, first-line babesia combination therapy should be considered given that more than one pathogen can be transmitted by a single tick bite.
One study found that 40% of individuals with Lyme disease in the Northeastern USA were also infected with Babesia.
References
- Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018;43(10):48-54.
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. Trends Parasitol. 2015.
