Which medications are indicated for the treatment of babesiosis in immunocompromised patients?

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

Highly immunocompromised adults:

  • Highly immunocompromised patients include the following:
    • Patients who are receiving or have received rituximab for B-cell lymphoma or autoimmune disease
    • Patients on immunosuppressive regimens for solid organ or bone marrow transplantations or malignancy
    • Patients who have malignancy and are asplenic
    • Patients who have HIV with a CD4 count of less than 200 (AIDS)
  • These patients should receive the regimen for hospitalized adults with acute severe disease, followed by step-down therapy, but treatment must be continued for at least 6 consecutive weeks, and peripheral blood smears should be free of parasites for the 2 final weeks of this period.
  • As previously stated, higher doses of oral azithromycin (500-1000 mg daily) should be considered in these patients when oral azithromycin is appropriate.

Highly immunocompromised children:

  • Include the same group of highly immunocompromised patients described above in the adult regimens section.
  • These patients should receive the regimen for hospitalized children with acute severe disease, followed by step-down therapy, but treatment must be continued for at least 6 consecutive weeks, and peripheral blood smears should be free of parasites for the 2 final weeks of this period.
  • Relapse regimens in children are similar to the relapse regimens listed above for adults.

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