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Choukri Ben Mamoun, Gary P Wormser, Reply to Dow and Smith, The Journal of Infectious Diseases, Volume 230, Issue 1, 15 July 2024, Page 273, https://doi.org/10.1093/infdis/jiae194
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To theEditor—In their recent letter [1], Dow and Smith proposed a treatment trial of hospitalized babesiosis patients (presumably infected with Babesia microti specifically) comparing a 3-drug treatment regimen consisting of 800 mg of tafenoquine (TAF) administered as a daily 200-mg dose over the first 4 consecutive days of treatment in combination with a 10-day course of azithromycin plus atovaquone, also initiated on day 1 of treatment. Presumably, the subjects enrolled would be patients who were to receive their first treatment for babesiosis, rather than patients experiencing relapsing infection despite having been previously treated with 1 or more antibabesia drug regimens. The 2-drug regimen of azithromycin plus atovaquone alone is generally considered to be the preferred initial treatment regimen for B. microti infections [2], and this regimen will serve as the 10-day comparator in this trial, and will be given in conjunction with an initial 4-day course of a matching TAF placebo.