Babesia Infection Protocol

By now most of you have heard about Babesia. You have heard how deadly it is. The American Pit Bull Terrier is one of the most commonly affected breeds so we all need to be aware of the symptoms and how to treat them in a moment’s notice. Babesia kills thousands of dogs every year. For those of you who do not know what Babesia is, it is a blood parasite that attacks the red blood cells; this attack results in hemolytic anemia. It has been said that Babesia is so prevalent in our breed that it is very likely that nearly every kennel in the United States has at least one Babesia-positive dog. Many dogs that have Babesia will show no clinical signs of the disease which makes eradicating it nearly impossible.

If your dog displays any of the following clinical signs, suspect Babesia: pale gums, lack of appetite, lethargy, jaundiced and/or dark urine. Any dogs displaying these signs should immediately be brought to the vet, time is of the essence. Once these signs are visible the dog is in bad shape and could possibly need a blood transfusion to buy them time. Be aware that most vets are probably going to misdiagnose your dog with Autoimmune Disease. You must be prepared for this. You should demand a blood sample be sent overnight to North Carolina State University’s Vector Borne Disease Diagnostic Laboratory (Link to Test Form Below). Do not let your vet send the bloodwork to any other labs. NC State is the leader in Vector Borne Diseases and your dog deserves the best. If your vet gives you any pushback, remember that you are a paying customer and the vet is there to service YOUR needs so insist this is done. You want a Polymerase Chain Reaction test done on the blood (otherwise known as a PCR Test). It is imperative that these samples be drawn and sent BEFORE the vet prescribes any medication as this can skew the testing resulting in false negatives. You will also want a Canine Serology test ran. This information is critical in properly treating the disease. The test results will take anywhere from 5- 10 days to come back. In the meantime, your vet will probably prescribe a broad spectrum antibiotic such as Doxycycline and they almost always prescribe prednisone. Giving the Doxycycline is good, but prednisone is an immune suppressant that can drastically affect the dog’s ability to recover if he does in fact have Babesia. Stay away from the Prednisone until the test results come back. If you are in dire straits, an injection of Diminazine Aceturate (Brand Name: Berenil) can be given at a dosage of 3.5–7 mg/kg IM every 1–2 weeks (not FDA approved). This drug can be purchased online from pharmacies in South Africa without a prescription, and if you keep Berenil on hand your vet can administer it. If you do not have access to Berenil you could give Imidocarb Dipropionate (Brand Name: Imizol) instead. This is dosed at 6.6 mg/kg IM every 1–2 weeks (FDA approved). These drugs will not cure the disease but they will buy you time.

You will notice improvement within 24 hours and within a few days you will think your dog is cured - don’t be fooled. It is only a matter of time before the dog relapses. If your bloodwork comes back positive from North Carolina State University your next step is to get your dog on the following medication: 

• Azithromycin dosed at 10 mg/kg by mouth once a day for 10 days.
• Atovaquone (Brand Name: Mepron), dosed at 13.3 mg/kg by mouth with a fatty meal every 8 hours for 10 days. It is critical that the Mepron be given with a fatty meal and like clockwork every 8 hours to ensure efficacy.

Repeat PCR Tests should be performed 30, 60 and 90 days post treatment to ensure the Babesia was eliminated.

If your dogs PCR shows a decreasing RBC and HCT's it is likely a strain resistant to the Azithromycin/Atovaquone combo (~15% won’t clear with AA treatment). In the past you would be instructed to repeat the Azithromycin and Atovaquone treatment. This is now outdated.

New treatment protocol for resistant Babesiosis is:

• clindamycin (25 mg/kg q12h PO)
• doxycycline (5 mg/kg q12h PO)
• metronidazole (15 mg/kg q12h PO)
• given daily for 3 months

Please note: this new treatment combination for resistant Babesiosis should only to be used if the Azithromycin/Atovaquone combo fails to result in a clear PCR.

In the past, it’s been very expensive to treat a Babesia-positive dog. Let’s face it; money is a concern for most of us. Our dogs usually find a way to get sick at the worst time and most of us do not have an extra $1,000 laying around. Many dogs have died because they never received the treatment they needed. You can now treat most dogs for under $200 by getting a little creative. Instead of ordering Atovaquone from a normal pharmacy, you can obtain Atovaquone from a compounding pharmacy. A compounding pharmacy is basically a pharmacy that buys large quantities of drugs in bulk, and then dispenses them in smaller dosages. Their economies of scale gives compounding pharmacies the ability to sell the drugs less expensively. A popular compounding facility is Wedgewood Pharmacy (www.wedgewoodpharmacy.com). A recent study** published in 2014 determined that the use of compounded Atovaquone capsules were as effective as and less expensive than the commercially available version.

So there you have it. As responsible dog owners we need to be aware and prepared to handle anything that can possibly pose a threat to our dogs. Babesia is here and here to stay. If we don’t treat this disease seriously it can wipe out entire kennels and bloodlines. Knowledge is power. Together we can make a difference, so please share this document. Save it somewhere safe so if you ever need it, you have it. Best of luck.

TEST FORM: NCSU Test Request Form

*Kirk's Current Veterinary Therapy XV By John D. Bonagura, DVM, MS, DACVIM and David C. Twedt, DVM, DACVIM: from Chapter 268 by ADAM J. BIRKENHEUER

**Efficacy of Azithromycin and Compounded Atovaquone for Treatment of Babesia gibsoni in a Large-Scale Dogfighting Case ACVIM 2014