title: Atovaquone plus cholestyramine in patients coinfected with Babesia microti and Borrelia burgdorferi refractory to other treatment.
abstract: Ten percent of US patients with Lyme disease are coinfected with Babesia microti. A double-blind, placebo-controlled, crossover trial enrolled 25 patients with confirmed Borrelia burgdorferi/B microti coinfection, abnormal visual contrast sensitivity (VCS), and persistent symptoms despite prior treatment with atovaquone and azithromycin. Patients were randomly assigned to atovaquone suspension or placebo plus cholestyramine for 3 weeks, were crossed over for 3 weeks, and then received open-label atovaquone and cholestyramine for 6 weeks. Symptoms and VCS scores were recorded at baseline and after weeks 3, 6, 9, and 12. Improvements in symptoms and VCS deficits were observed only after at least 9 weeks of treatment. At week 12, 5 patients were asymptomatic, and 16 had a notable reduction in the number of symptoms. The entire cohort demonstrated significant increases in VCS scores. Adverse effects were rare. Patients coinfected with B burgdorferi and B microti derive measurable clinical benefit from prolonged treatment with atovaquone and cholestyramine. Longer-term combination therapy may be indicated.
authors.affiliation: Center for Research on Biotoxin-Associated Illnesses Pocomoke City, Maryland 21851, USA.
authors.forename: Ritchie C
authors.initials: RC
authors.lastname: Shoemaker
authors.forename: H Kenneth
authors.initials: HK
authors.lastname: Hudnell
authors.forename: Dennis E
authors.initials: DE
authors.lastname: House
authors.forename: Amy
authors.initials: A
authors.lastname: Van Kempen
authors.forename: Gary E
authors.initials: GE
authors.lastname: Pakes
mesh_terms: D000328:Adult; D000837:Anion Exchange Resins / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D053626:Atovaquone; D041001:Babesia microti; D001404:Babesiosis / Q000150:complications / Q000188:drug therapy*; D002792:Cholestyramine Resin / Q000008:administration & dosage / Q000627:therapeutic use*; D015350:Contrast Sensitivity; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009285:Naphthoquinones / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000837:Anion Exchange Resins; D000981:Antiprotozoal Agents; D009285:Naphthoquinones; D002792:Cholestyramine Resin; D053626:Atovaquone