Dr. Horowitz: OneTreatment Study for Babesiosis
Rita Stanley
Babesiosis in humans. Below is one paper that showed his exploration of one
method.
Rita
HIGH DOSE TRIMETHOPRIM-SULFAMETHOXAZOLE THERAPY: A USEFUL ADJUNCT TO
COMBINATION THERAPY IN TREATMENT RESISTANT BABESIOSIS
Richard Horowitz, MD
12th Int. Conf. on LD & Other Spirochetal & Tick-borne Disorders
April 1999, New York City
BACKGROUND: Krause described persistent parasitemia after acute babesiosis
when patients were given Cleocin and Quinine (C + Q) (NEJM 7/98 Vol 339,
160-165). Horowitz described significant clinical improvement among chronic
Lyme patients co-infected with Babesia microti when given Atovaquone and
Zithromax (M & Z) (Abstract, 11th International Sci. conf. on LD, NYC,
4/98), however persistence of Babesia DNA & RNA has been noted with both
regimens despite repeated courses of both antibiotics (Horowitz, RI:
Abstract, 12th Int. Conf. On LD & Other Spirochetal & Tick-borne disorders,
NYC, NY 4/99). Gupta et al describe parasitemia resolving with the addition
of high dose Trimethoprim-sulfamethoxazole (T/S) to a regimen of Atovaquone,
Cleocin & Quinine (Am. J. Hemat. 50:60-62, 1995). This report describes an
improved treatment regimen for resistant Babesiosis using high dose T/S in
combination therapy.
METHODOLOGY: Babesia microti infections were diagnosed among a cohort of 30
chronic Lyme disease patients using both IFA and PCR/RNA analysis (27/30
patients were PCR and/or RNA positive). Patients were divided into 4
treatment groups, using either low dose T/S (Bactrim DS, one QID) or high
dose T/S (two QID). Most patients had already received either C+Q or M+Z
alone, and patients self selected their treatment regimen based on their
prior tolerability of the drugs. Group I received Cleocin 600 mg. TID +
Quinine 650 mg. TID (C+Q) for 7 days with low dose T/S for 7-10 days. Group
2 received C+Q + high dose T/S for 7-10 days. Group 3 received Atovaquone
750 mg. PO BID + Azithromycin 600 mg. PO QD (M+Z) for 21 days with low dose
T/S during the last 10 days of treatment, with Group 4 receiving the same
regiment with high dose T/S. PCR and/or RNA analysis was performed
post-treatment in all 4 groups, and success or failure was defined according
to persistent parasitemia as evidenced by PCR/RNA positivity post treatment.
RESULTS: 22/30 patients (73%) completed the treatment regimen, with 2
patients switching from high dose to low dose T/S secondary to GI
intolerance. 7 patients (23%) dropped out secondary to nausea, vomiting,
rashes and/or flaring of symptoms. One patient was lost to follow-up. PCR
and/or RNA analysis was able to be obtained on 18/22 patients completing the
study. Group 1 (low dose T/S) had 3 failures and 1 success. Group 2 (high
dose T/S) had 1 success and no failures. Group 3 (low dose T/S) had 5
failures, and no success. Group 4 (high dose T/S) had 7 successes and only
1 failure. Overall the high dose T/S regimen (groups 2 & 4) had an 89%
success rate, while the low dose T/S regimen had an 89% failure rate.
CONCLUSIONS: High dose T/S when added to either C+Q or M+Z significantly
improved the eradication rate of Babesia microti. Lyme disease patients
with chronic persistent symptomatology may be co-infected, and those
patients who cleared their parasitemia as evidenced by PCR/RNA negativity
post-treatment showed significant sustained clinical improvement. GI
tolerance was generally poor, and routine use of anti-nausea agents is
recommended, with M+Z being better tolerated than C+Q. M+Z with high dose
T/S may therefore represent an effective, better tolerated 1st line
treatment for chronic persistent babesiosis.