Babesiosis Guidelines

Updated: Apr 01, 2021
  • Author: Rachel E Strength, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Guidelines Summary

Infectious Diseases Society of America (IDSA)

 The Infectious Diseases Society of America (IDSA) has published guidelines for diagnosing and managing babesiosis. [3]


The IDSA recommends peripheral blood smear examination or polymerase chain reaction (PCR) rather than antibody testing for diagnostic confirmation of acute babesiosis.

The IDSA recommends confirmation of a positive Babesia antibody test with blood smear or PCR before considering treatment.


The IDSA recommends treating babesiosis with the combination of atovaquone plus azithromycin or the combination of clindamycin plus quinine.

The IDSA suggests exchange transfusion using red blood cells in selected patients with severe babesiosis.

The IDSA recommends monitoring Babesia parasitemia during treatment of acute illness in immunocompetent patients using peripheral blood smears. The IDSA recommends against testing for parasitemia once symptoms have resolved in this patient group.

The IDSA suggests monitoring Babesia parasitemia in immunocompromised patients using peripheral blood smears even after patients become asymptomatic and until blood smears are negative. The IDSA suggests PCR testing be considered if blood smears become negative and symptoms persist in the immunocompromised population.