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

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.