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J Vet Intern Med. 2009 May-Jun;23(3):493-8. doi: 10.1111/j.1939-1676.2009.0300.x.

Possible emergence of drug-resistant variants of Babesia gibsoni in clinical cases treated with atovaquone and azithromycin.

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1
Laboratory of Veterinary Internal Medicine, Faculty of Agriculture, Kagoshima University, Kagoshima, Japan.

Abstract

BACKGROUND:

There is no well-established treatment strategy for Babesia gibsoni infection. A new therapeutic protocol using atovaquone (ATV) and azithromycin (AZM) has been proposed, but there is concern about the possible induction of relapse and the emergence of ATV-resistant variants after treatment.

OBJECTIVE:

To evaluate the clinical use of combination therapy with ATV and AZM as a first-line treatment of clinical B. gibsoni infection in dogs, and to investigate the emergence of ATV-resistant variants.

ANIMALS:

Eight B. gibsoni naturally infected dogs showing signs of acute onset of disease.

METHODS:

Retrospective case study. Eight clinical cases received combination therapy with ATV and AZM at Kagoshima University Veterinary Teaching Hospital during 2007-2008, and their clinical courses and clinicopathological parameters were evaluated. In addition, alterations in the cytochrome b (CYTb) gene of B. gibsoni were analyzed by polymerase chain reaction and DNA sequencing techniques.

RESULTS:

All of the dogs responded well to the treatment, with rapid improvement in their clinical condition and hematological parameters. However, 5 of the 8 dogs relapsed after treatment. Analysis of the CYTb gene strongly suggested the emergence of ATV-resistant variants after treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE:

The combination of ATV and AZM can be used as a first-line treatment for dogs with babesiosis, but relapses occur. Attention should be paid to the possible in vivo selection of drug-resistant variants.

PMID:
19645835
DOI:
10.1111/j.1939-1676.2009.0300.x
[Indexed for MEDLINE]
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