antimicrobials in severe babesiosis

Q: All of the following antimicrobials are found to be effective in the treatment of severe babesiosis except?

A) Azithromycin 
B) Atovaquone
C) Clindamycin 
D) Levofloxacin
E) Quinine 


Answer: D

The most commonly used drug regimen for severe babesiosis is intravenous azithromycin plus oral atovaquone. Intravenous clindamycin plus oral quinine can be used as an alternative treatment. Therapy should be guided by the level of parasitemia and blood smears. 

Red blood cell exchange transfusion should be considered as an immediate life-saving therapy or if antimicrobial therapy fails.



References:

1. Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012; 366:2397. 

2.  Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA 2016; 315:1767. 

3. Kletsova EA, Spitzer ED, Fries BC, Marcos LA. Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone. Ann Clin Microbiol Antimicrob 2017; 16:26.