Atovaquone plus cholestyramine in patients coinfected with Babesia microti and Borrelia burgdorferi refractory to other treatment

Adv Ther. 2006 Jan-Feb;23(1):1-11. doi: 10.1007/BF02850341.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anion Exchange Resins / administration & dosage
  • Anion Exchange Resins / therapeutic use*
  • Antiprotozoal Agents / administration & dosage
  • Antiprotozoal Agents / therapeutic use*
  • Atovaquone
  • Babesia microti
  • Babesiosis / complications
  • Babesiosis / drug therapy*
  • Cholestyramine Resin / administration & dosage
  • Cholestyramine Resin / therapeutic use*
  • Contrast Sensitivity
  • Cross-Over Studies
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Humans
  • Lyme Disease / complications
  • Lyme Disease / drug therapy*
  • Male
  • Middle Aged
  • Naphthoquinones / administration & dosage
  • Naphthoquinones / therapeutic use*


  • Anion Exchange Resins
  • Antiprotozoal Agents
  • Naphthoquinones
  • Cholestyramine Resin
  • Atovaquone