Pediatric Babesiosis Treatment & Management

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C); Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 29, 2010
 

Medical Care

Most of the otherwise healthy patients infected by Babesia microti appear to have a mild illness and recover without specific chemotherapy; however, treatment is recommended for all diagnosed cases to prevent sequelae and potential transmission through blood donation.

Babesiosis is generally treated with a combination of clindamycin (20 mg/kg/d for children; 300-600 mg intravenously [IV] or intramuscularly [IM] every 6 h for adults) and oral quinine (25 mg/kg/d for children; 650 mg every 6-8 h for adults) administered for 7-10 days. Occasional failure of this therapy has been reported. Immunocompromised individuals who are infected by B microti are at risk for persistent relapsing illness. Such patients generally require antibabesial treatment for 6 weeks or longer to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.[7]

A combination of atovaquone and azithromycin appears to be a promising alternative. In a prospective nonblinded randomized study in 2000, Krause and colleagues found that a regimen of atovaquone (750 mg every 12 h) and azithromycin (500 mg on day 1 and 250 mg/d thereafter) was as effective as a combination of clindamycin (600 mg every 8 h) and quinine (650 mg every 8 h) in producing a clinical response and producing the clearance of parasitemia.[8] All patients were treated for 7 days. Adverse effects were reported by 15% of the patients who received atovaquone and azithromycin, compared with 72% of those who received clindamycin and quinine.

The combination of clindamycin, doxycycline, and azithromycin was successfully used in a patient who was allergic to quinine.

A patient with acquired immune deficiency syndrome (AIDS) and babesiosis failed treatment with azithromycin and atovaquone followed by quinine and clindamycin. The addition of atovaquone-proguanil to the treatment regimen led to cure.[9]

Exchange transfusions are used in patients who are profoundly ill with high levels of parasitemia and hemolysis. When used concurrently with chemotherapy, exchange transfusion reduces the level of parasitemia and may remove toxic erythrocyte, babesial, or macrophage-produced factors.

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Consultations

Consult an infectious diseases specialist for appropriate antibiotic therapy.

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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C)  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center, Downey, California.

Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Coauthor(s)

Allan D Friedman, MD, MPH  Chairman, Division of General Pediatrics, Dept of Pediatrics, Professor of Pediatrics, Virginia Commonwealth University, VCUH Health System

Allan D Friedman, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
Blood smear showing Babesia species in erythrocytes. Courtesy of the Centers for Disease Control and Prevention.
Babesia species, tetrad formation. Courtesy of the Centers for Disease Control and Prevention.
 
 
 
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