Walsh & Hoyt: Treatment and Prognosis

Most patients with babesiosis who are infected with B. microti, at least those in the United States, have a mild illness that resolves without treatment. Asplenic, immunocompromised, or elderly patients are more likely to become severely ill. These patients require aggressive supportive care, antiprotozoal therapy, and, in some cases, exchange transfusion and dialysis if they are to survive. Adult respiratory distress syndrome can occur following treatment, perhaps from changes in erythrocyte function and cytokine release. Clindamycin and quinine are standard therapy, with atovaquone and azithromycin being an alternative regimen. The physician caring for a patient with known or suspected babesiosis should obtain the advice of an expert in infectious diseases before beginning specific medical therapy.