Babesiosis Clinical Practice Guidelines (IDSA, 2020)

Infectious Diseases Society of America

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

February 01, 2021

Guidelines for diagnosing and managing babesiosis were published in November 2020 by the Infectious Diseases Society of America (IDSA).[1]


The IDSA recommends peripheral blood smear examination or polymerase chain reaction (PCR) rather than antibody testing for diagnostic confirmation of acute babesiosis.

The IDSA recommends confirmation of a positive Babesia antibody test with blood smear or PCR before considering treatment.


The IDSA recommends treating babesiosis with the combination of atovaquone plus azithromycin or the combination of clindamycin plus quinine.

The IDSA suggests exchange transfusion using red blood cells in selected patients with severe babesiosis.

The IDSA recommends monitoring Babesia parasitemia during treatment of acute illness in immunocompetent patients using peripheral blood smears. The IDSA recommends against testing for parasitemia once symptoms are resolved.

The IDSA suggests monitoring Babesia parasitemia in immunocompromised patients using peripheral blood smears even after patients become asymptomatic and until blood smears are negative. The ISDA suggests PCR testing be considered if blood smears become negative but symptoms persist.

For more Clinical Practice Guidelines, go to Guidelines.

For more information, go to Babesiosis.


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