An alternative combination therapy with metronidazole, clindamycin and doxycycline for <i>Babesia gibsoni</i> (Asian genotype) in dogs in Hong Kong

Abstract

Babesia spp. are globally distributed hemoparasites that cause disease in many mammalian species. The species Babesia gibsoni (Asian genotype) is prevalent and endemic in many Asian countries but has also been reported in growing numbers in countries outside of Asia. Standard therapies for the treatment of B. gibsoni often fail to result in consistent and successful clearance of the organism. This study evaluated the use of a combination of three antibiotics: metronidazole, clindamycin and doxycycline after atovaquone and azithromycin failed to eliminate the infection on a polymerase chain reaction (PCR) test. The aim of this study was to determine whether the triple antibiotic combination was an appropriate alternative or additional treatment for the elimination of B. gibsoni. The medical records of 24 patients treated from December 2012 to July 2015 were retrospectively analyzed. The diagnosis of B. gibsoni was confirmed with a PCR test that was also used to assess treatment response. All patients were initially treated with the standard therapy, atovaquone and azithromycin with a 25% success rate clearing B. gibsoni. Dogs that remained positive on PCR using the standard therapy were then treated with the triple antibiotic protocol achieving an 87% success rate. The inclusion of an alternative and potentially effective protocol for the treatment of B. gibsoni would increase the options for the current therapeutic options, could aid in clearance of the organism and offer a more affordable option for clients.

Multiple complications in a dog infected with Babesia gibsoni

“…12,13 Currently, atovaquone (13 mg/kg PO q8h) and azithromycin (10 mg/kg PO q24h), given for ten days is considered the standard protocol for B. gibsoni infection. 14 Other protocols developed in Asian universities have nonetheless been shown to be comparable or even a superior alternative, including clindamycin (25 mg/kg PO q12h), doxycycline (5 mg/kg PO q12h) and metronidazole (15 mg/kg PO q12h), 15 and enrofloxacin (2-2.5 mg/kg q12h), doxycycline (7-10 mg/kg PO q12h) and metronidazole (5-15 mg/kg PO q12h). 16 The prognosis for B. gibsoni infection is generally good with a reported survival of up to 90% of cases treated with appropriate antibabesial therapy.…”

Successful Treatment of Babesiagibsoni Infection in a Pug Dog - A Case Report

“…Effective management of dogs with babesiosis involves both specific and supportive strategies. Supportive treatment is aimed at restoring adequate tissue oxygenation by correction of anemia in severe conditionsand correction of dehydration and electrolyte disturbances as also mentioned by Bhojne et al, 2013. The triple therapy with three antibiotics Clindamycin @ 25mg/kg PO q 12h, Metronidazole @ 15mg/kg PO q 12h and Doxycycline @ 5mg/kg PO q 12h is an efficacious treatment strategy for B. gibsoni infection with no reported adverse effects as also reported by Swamy et al, 2019. Triple antibiotic protocol showed 87% of success rate in clearance of organism in dogs that remained positive on PCR after atovaquone and azithromycin therapy as also recommended by Almendros et al, 2020. Diminazene aceturate is also a relatively effective treatment. Although doses of 3.5 to 5 mg/kg are often effective in B. canis infections, doses of 7.5 to 10 mg/kg are recommended in treating B. gibsoni infections.…”

Successful treatment with doxycycline monotherapy for human infection with Babesia venatorum (Babesiidae, Sporozoa) in China: a case report and clinic regimen

“…In 1996, the prophylactic treatment of experimental canine babesiosis (B. canis) with doxycycline was achieved with satis ed e cacy [23] . Another option is an alternative combination therapy regime that works well with metronidazole, clindamycin, and doxycycline for B. gibsoni (Asian genotype) infection in dogs in Hong Kong [24] . Doxycycline, a tetracycline antibiotic, is widely used to treat various pathogens, such as a 10-day course of oral doxycycline for the treatment of human granulocytic anaplasmosis, 14-day course of oral doxycycline for the treatment of early neurologic Lyme disease, and 6-week course of oral doxycycline plus rifampicin for the treatment of acute brucellosis [28,29] .…”

“…However, emergency conscription for quinine and atovaquone is not available in China. As an alternative chemical, doxycycline has been shown to have sensitive antiparasitic activities by inhibiting the synthesis of apicoplast protein in Plasmodium species and successfully treating Babesia canis and Babesia gibsoni infection in dogs [23,24] . Moreover, due to the use of doxycycline, the patient's clinical symptoms have gradually eased.…”