Atovaquone and Azithromycin for the Treatment of Babesiosis

Krause, Peter J.; Lepore, Timothy J.; Sikand, Vijay K.; Gadbaw, Joseph; Burke, Georgine; Telford, Sam R.; Brassard, Peter; Pearl, Diane; Azlanzadeh, Jaber; Christianson, Diane; McGrath, Debra; Spielman, Andrew

doi:10.1056/nejm200011163432004

Cited by 328 publications

(188 citation statements)

References 22 publications

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“…Combination therapies, usually consisting of an antimalarial agent and an antibiotic, such as azithromycin/quinine [11], clindamycin/quinine [12], azithromycin/atovaquone [13,14], and atovaquone/proguanil [15], were recommended and applied clinically for the treatment of babesiosis. Generally, combination therapies can suppress parasitemia, and most patients do not relapse after standard antibabesial therapy.…”

Section: Introductionmentioning

confidence: 99%

Inhibitory effects of 19 antiprotozoal drugs and antibiotics on Babesia microti infection in BALB/c mice

Yao

Zhang

Liu

et al. 2015

J Infect Dev Ctries

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Introduction: Different results have been achieved in the evaluation of antiparasitic drug activity in Mongolian jirds, hamsters, and BALB/c mice infected with Babesia microti. The aims of the present study were to find a preferable method for drug screening and to re-evaluate the activity of several drugs against B. microti. Methodology: The activity of 19 drugs on B. microti-infected BALB/c mice was evaluated. The study was built on Peters' four-day suppressive test, and the pathogenicity of the blood from the treated mice was also used as indicator. Results: The results showed that 15 of the 19 drugs had little or no in vivo effect against B. microti. The inhibitory rates of atovaquone and azithromycin were high at all doses, but the microscopy-negative blood of recovered mice was still infectious. Similar to robenidine hydrochloride at 25 and 50 mg/kg, primaquine at 100 mg/kg had a 100% inhibitory rate. Robenidine hydrochloride achieved a 100% inhibitory rate at 100 mg/kg, and the blood of recovered mice did not result in parasitemia in subpassage experiments. Parasite-negative blood from mice treated with antimalarial drugs (clinically used for babesiosis) still caused parasitemia in subpassage experiments. This suggests that these drugs cannot eradicate the parasites. Conclusions: Peters' four-day suppressive test and the pathogenicity of the blood from the treated mice are suitable methods for preliminary investigating possible drugs against B. microti. Considering that robenidine hydrochloride achieved the best activity against B. microti in BALB/c mice in our study, further studies are needed.

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Section: Introductionmentioning

confidence: 99%

Inhibitory effects of 19 antiprotozoal drugs and antibiotics on Babesia microti infection in BALB/c mice

Yao

Zhang

Liu

et al. 2015

J Infect Dev Ctries

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“…Atovaquone has also been shown to be effective for the treatment of mild and moderate P. carinii pneumonia, 86 and, in combination with azithromycin, for the treatment of babesiosis, caused by Babesia microti, a tickborne, malaria-like infection that may cause severe illness and death and which is enzootic, mainly in southern New England, southern New York, Wisconsin and Minnesota. 87 For readers who would like further information on lapachol and its congeners as anticancer agents, the 2014 review by Epifano et al 88 should be consulted. Finally, as in the case of most of the agents discussed in this review, microbes appear again as possible source(s) for one of the natural products discussed in this section.…”

Section: Lapachol and Lapachonementioning

confidence: 99%

The Influence of Brazilian Biodiversity on Searching for Human Use Pharmaceuticals

Newman¹

2016

J. Braz. Chem. Soc.

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This relatively short review will cover the history of some potential drug entities whose beginnings were from Brazilian flora and fauna that led to scientific findings many years later that could not even have been thought of at the time of their initial discovery. The first two are the discoveries of the effects of peptidic toxins from the highly poisonous snake Bothrops jararaca upon the control of bradykinins that led to the angiotensin converting enzyme inhibitors, and the identification of pederin from the blister beetle Paederus species that 50 plus years later led to brand new discoveries as the source of many marine sponge metabolites. All occurred well before the Convention on Biological Diversity (CBD), in 1992. Then come discussions on lapachol and its congeners and then the potential for the investigation of microbes that are associated with insects, plants and marine invertebrates and their control of the syntheses of novel metabolites with pharmaceutical potential. The review finishes with comments on the biodiversity programs that São Paulo State has put in place and how they are materially aiding in investigations of Brazilian flora and fauna but under conditions that are CBD-compliant.

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“…Clindamycin 600 mg every 8 hours taken orally plus quinine 650 mg orally every 8 hours for 7 to 10 days have efficacy proven in Literature in milder forms of disease [30,31], while the intravenous use of clindamycin is preferred in more severe disease forms. Alternative and similarly effective treatments are atovaquone 750 mg twice daily taken orally plus azithromycin 250 mg daily except for the fisrt day of treatment (500 mg) for 7 days as well.…”

Section: Babesia Speciesmentioning

confidence: 99%

Impact of Co-Infections in Lyme Disease

Stinco¹,

Bergamo²

2016

TODJ

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Atovaquone and Azithromycin for the Treatment of Babesiosis

Abstract: For the treatment of babesiosis, a regimen of atovaquone and azithromycin is as effective as a regimen of clindamycin and quinine and is associated with fewer adverse reactions.

Cited by 328 publications

References 22 publications

Inhibitory effects of 19 antiprotozoal drugs and antibiotics on Babesia microti infection in BALB/c mice

Inhibitory effects of 19 antiprotozoal drugs and antibiotics on Babesia microti infection in BALB/c mice

The Influence of Brazilian Biodiversity on Searching for Human Use Pharmaceuticals

Impact of Co-Infections in Lyme Disease

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