Table 3.

Treatment of babesiosis.

Treatment	Dose	Frequency
Atovaquone and azithromycin
Atovaquone	Adult: 750 mg	Every 12 hours
	Child: 20 mg/kg	Every 12 hours
	(maximum 750 mg/dose)
Azithromycin	Adult: 500 to 1000 mg	On day 1
	250 to 1000 mg	On subsequent days
	Child: 10 mg/kg	On day 1
	(maximum 500 mg/dose)
	5 mg/kg	On subsequent days
	(maximum 250 mg/dose)
Clindamycin and quinine
Clindamycin	Adult: 600 mg	Every 8 hours
	Child: 7–10 mg/kg	Every 6–8 hours
	(maximum 600 mg/dose)
	Intravenous administration
	Adult: 300–600 mg	Every 6 hours
	Child: 7–10 mg/kg	Every 6–8 hours
	(maximum 600 mg/dose)
Quinine	Adult: 650 mg	Every 6–8 hours
	Child: 8 mg/kg	Every 8 hours
	(maximum 650 mg/dose)

All antibiotics are administered by mouth unless otherwise specified. All doses are administered for 7 to 10 days except for persistent relapsing infection (see text). For immunocompromised patients experiencing babesiosis, successful outcome has been reported using atovaquone combined with higher doses of azithromycin (600–1000 mg per day) [78].

Complete or partial exchange transfusion should be considered for treatment of severe babesiosis.