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==Management==
==Management==
*2 drug regimen for 7-10 days
*2 drug regimen for 7-10 days
antibiotic and antimalarial therapy should be started immediately after diagnosis to reduce the level of parasitemia. The standard treatment has been a combination of However, this regimen occasionally fails, and patients report frequent side effects, including tinnitus, impaired hearing, and diarrhea.
Consequently, a drug regimen consisting of atovaquone and azithromycin is now first-line treatment for mild-to-moderate disease and has been shown to be effective, especially when clindamycin and quinine fail.
In a prospective nonblinded randomized study, Krause et al found that atovaquone (750 mg every 12 hours) plus azithromycin (500 mg on day 1 and 250 mg/day thereafter) was as effective as clindamycin (600 mg every 8 hours) plus quinine (650 mg every 8 hours) in producing a clinical response and clearing parasitemia.[21] All patients were treated for 7 days. Adverse effects were reported by 15% of the atovaquone-azithromycin group and 72% of the clindamycin-quinine group.


===Option 1===
===Option 1===
Línea 37: Línea 30:
{{Babesiosis Clindamycin Adult}}
{{Babesiosis Clindamycin Adult}}


===Option 3===
===Pediatrics===
*Adults: Clindamycin 300-600 mg IV or IM every 6 hour '''and''' PO quinine 650 mg every 6-8 hours for 10 days
*Clindamycin 20 mg/kg/day for children and 25 mg/kg/day for children for 7-10 days
*Pediatrics: Clindamycin 20 mg/kg/day for children and 25 mg/kg/day for children for 10 days
 
===Treatment Failure===
*Atovaquone 750 mg q12 '''and''' azithromycin 500 mg on day 1 and 250 mg/day x 7 days<ref>Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. Nov 16 2000;343(20):1454-8.</ref>


==See Also==
==See Also==

Revisión del 15:03 4 jun 2015

Background

  • Spread by the deer tick (Ixodes scapularis)
    • People often unaware they are bitten
  • Natural reservior is the white footed mouse
  • Endemic in US, Europe, parts of Russia and China
    • Babesia Microti is pathogen in US

Symptoms

Diagnosis

  • Peripheral blood smear
    • Shows intracellular parasites
      • Maltese Cross sign
    • May need large smear as parasitemia can be as low as 1%
    • Can often be confused for malaria parasites

Differential Diagnosis

Tick Borne Illnesses

Management

  • 2 drug regimen for 7-10 days

Option 1

  • Atovaquone (750mg BID) and Azithromycin (500-1000mg on first day, 250-1000mg on subsequent days)

Option 2

Clindamycin

  • Clindamycin 600mg PO q8hrs x 7-10 days (or 300-600mg IV q6hrs)
  • Give with Quinine 650mg TID

Pediatrics

  • Clindamycin 20 mg/kg/day for children and 25 mg/kg/day for children for 7-10 days

Treatment Failure

  • Atovaquone 750 mg q12 and azithromycin 500 mg on day 1 and 250 mg/day x 7 days[1]

See Also

Sources

  1. ↑ Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. Nov 16 2000;343(20):1454-8.
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