What is Atovaquone used for. How should Atovaquone be taken. What are the common side effects of Atovaquone. How does Atovaquone work against PCP. When should you consult a doctor while taking Atovaquone. What precautions should be taken with Atovaquone.

Understanding Atovaquone: An Antiprotozoal Agent for PCP

Atovaquone is a medication primarily used in the treatment and prevention of Pneumocystis jiroveci pneumonia (PCP), a type of pneumonia that commonly affects individuals with compromised immune systems, particularly those with HIV. As an antiprotozoal agent, Atovaquone works by inhibiting the growth of specific protozoa responsible for causing pneumonia.

Primary Uses of Atovaquone

• Treatment of PCP in teenagers and adults
• Prevention of PCP in individuals who cannot tolerate other preventive medications
• Potential use in treating babesiosis (in combination with other drugs)

Are there specific groups that benefit most from Atovaquone? Immunocompromised individuals, especially those with HIV, are the primary beneficiaries of Atovaquone therapy. Its ability to both treat and prevent PCP makes it a valuable tool in managing opportunistic infections in these patients.

Atovaquone Administration and Dosage Guidelines

Atovaquone comes in a liquid suspension form, designed for oral administration. The dosage and frequency of intake depend on whether it’s being used for treatment or prevention of PCP.

Treatment Regimen

For treating PCP, Atovaquone is typically prescribed as follows:

• Taken twice daily with meals
• Treatment course lasts for 21 days
• Dosage times should be consistent each day

Prevention Regimen

When used for PCP prevention, the regimen differs slightly:

• Taken once daily with a meal
• Ongoing administration as directed by a healthcare provider

Is proper administration crucial for Atovaquone’s effectiveness? Absolutely. Taking Atovaquone with meals is essential as it significantly enhances the absorption of the medication. Consistency in timing and adherence to the prescribed regimen are key factors in ensuring optimal therapeutic outcomes.

Proper Handling and Administration of Atovaquone Suspension

To ensure accurate dosing and optimal effectiveness, proper handling of Atovaquone suspension is crucial:

1. Gently shake the bottle before each use to ensure even distribution of the medication.
2. Use a dosing spoon or cup to measure the correct amount, avoiding regular household spoons.
3. For packaged doses, drink directly from the packet or pour into a dosing device.

Can improper administration affect Atovaquone’s efficacy? Indeed, incorrect dosing or not taking the medication with food can significantly reduce its absorption and effectiveness. Always follow the prescribed guidelines and consult your healthcare provider if you have any doubts about administration.

Potential Side Effects and Adverse Reactions to Atovaquone

While Atovaquone is generally well-tolerated, it can cause various side effects. Understanding these potential reactions is crucial for patients and caregivers.

Common Side Effects

• Nausea
• Vomiting
• Diarrhea
• Headache
• Dizziness
• Anxiety
• Sleep disturbances

Serious Side Effects

While rare, some side effects warrant immediate medical attention:

• Rash or hives
• Fever
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing
• Hoarseness or throat tightness

Should you stop taking Atovaquone if you experience side effects? It’s crucial not to discontinue Atovaquone without consulting your healthcare provider. Many side effects are manageable, and the benefits of the medication often outweigh the risks, especially in preventing life-threatening infections like PCP.

Drug Interactions and Precautions with Atovaquone

Atovaquone can interact with other medications, potentially altering its effectiveness or increasing the risk of side effects. Being aware of these interactions is essential for safe use.

Notable Drug Interactions

• Rifabutin (Mycobutin)
• Rifampin (Rifadin, Rimactane)

Do these interactions mean you can’t take Atovaquone with other medications? Not necessarily. Your healthcare provider can adjust dosages or monitor you more closely if you need to take interacting medications. Always inform your doctor about all medications, supplements, and herbal products you’re using.

Special Precautions

Certain conditions may require special consideration when using Atovaquone:

• Stomach or intestinal disorders
• Liver disease
• Pregnancy or breastfeeding

Is it safe to take Atovaquone during pregnancy? While there’s limited data on Atovaquone use during pregnancy, the potential benefits may outweigh the risks in preventing life-threatening infections. Always consult your healthcare provider for personalized advice.

The Importance of Completing the Full Course of Atovaquone

Adhering to the prescribed Atovaquone regimen is crucial for effective treatment and prevention of PCP. Stopping the medication prematurely, even if symptoms improve, can lead to incomplete treatment or reduced protection against future infections.

Consequences of Early Discontinuation

• Incomplete eradication of the infection
• Increased risk of recurrence
• Potential development of drug resistance

Why is it essential to continue Atovaquone even after feeling better? PCP-causing organisms may still be present even after symptoms subside. Completing the full course ensures thorough elimination of the infection and provides optimal protection against future occurrences.

Atovaquone in Combination Therapy for PCP and Other Infections

While Atovaquone is effective against PCP, it may not address all potential lung infections in immunocompromised patients. Healthcare providers often prescribe Atovaquone as part of a comprehensive treatment plan.

Combination Therapy Scenarios

• Co-administration with other antibiotics for broader coverage
• Use in combination with other medications for babesiosis treatment

Does combination therapy improve outcomes in PCP treatment? In many cases, yes. Combining Atovaquone with other medications can provide more comprehensive coverage against various pathogens and potentially improve treatment efficacy, especially in complex cases or severe infections.

Storage, Handling, and Disposal of Atovaquone

Proper storage and handling of Atovaquone are essential to maintain its effectiveness and safety. Following guidelines for disposal is also important for environmental and safety reasons.

Storage Guidelines

• Keep in the original container
• Store at room temperature
• Protect from excessive heat and moisture
• Keep out of reach of children

Disposal Recommendations

Unused or expired Atovaquone should be disposed of properly:

• Do not flush down the toilet or pour down the drain
• Use community drug take-back programs if available
• Mix with undesirable substance and place in sealed container before disposing in household trash

Can improper storage affect Atovaquone’s efficacy? Yes, exposure to extreme temperatures or moisture can potentially degrade the medication, reducing its effectiveness. Always store Atovaquone as directed and check for any visible changes in the suspension before use.

Atovaquone plays a crucial role in the management of PCP, a potentially life-threatening condition in immunocompromised individuals. Its unique mechanism of action, coupled with its ability to both treat and prevent PCP, makes it an invaluable tool in the medical arsenal against opportunistic infections. While generally well-tolerated, understanding potential side effects, drug interactions, and proper administration is key to maximizing its benefits and ensuring patient safety.

As research continues, Atovaquone’s potential applications may expand, possibly offering new treatment options for other protozoal infections. However, its primary role in PCP management remains paramount, underscoring the importance of proper use, adherence to prescribed regimens, and ongoing monitoring by healthcare professionals.

For individuals at risk of or diagnosed with PCP, Atovaquone represents a beacon of hope, offering effective treatment and prevention options. As with any medication, open communication with healthcare providers, careful adherence to prescribed regimens, and awareness of potential side effects are crucial components of successful therapy. By leveraging the benefits of Atovaquone while mindfully managing its use, patients and healthcare providers can work together to combat the challenges posed by PCP and improve overall health outcomes for vulnerable populations.

Atovaquone: MedlinePlus Drug Information

pronounced as (a toe’ va kwone)

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Atovaquone is used to treat Pneumocystis jiroveci [Pneumocystis carinii] pneumonia (PCP; type of pneumonia most likely to affect people with human immunodeficiency virus [HIV]) in teenagers and adults. Atovaquone is also used to prevent PCP in teenagers and adults who cannot take another medication used for prevention. Atovaquone is in a class of medications called antiprotozoal agents. It works by stopping the growth of certain types of protozoa that can cause pneumonia.

Atovaquone comes as a suspension (liquid) to take by mouth. When atovaquone is used to treat pneumonia, it is usually taken with meals twice a day for 21 days. When atovaquone is used to prevent pneumonia, it is usually taken with a meal once a day. Take atovaquone at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atovaquone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If your medication comes in a bottle, shake the bottle gently before each use to mix the medication evenly. Use a dose measuring spoon or a cup to measure the correct amount of liquid for each dose, not a regular household spoon.

If your medication comes in a packet, you may drink the medication directly from the packet or pour the medication into a dosing spoon or cup.

Take this medication until you finish the prescription. Do not stop taking the medication early even if you are taking it to treat pneumonia and you feel better. If you stop taking atovaquone too soon or skip doses, your infection may not be completely treated or you may not be protected from future infections.

If you have PCP, you may also have other types of lung infections. Atovaquone will not treat these infections. Your doctor may prescribe other antibiotics for you to take along with this medication.

Atovaquone is also sometimes used along with other medications to treat babesiosis (an infectious disease carried by ticks). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking atovaquone,

• tell your doctor and pharmacist if you are allergic to atovaquone, any other medications, or any of the ingredients in atovaquone suspension. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: rifabutin (Mycobutin) or rifampin (Rifadin, Rimactane). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had stomach or intestinal disorders or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking atovaquone, call your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Atovaquone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea
• headache
• dizziness
• anxiety
• difficulty falling asleep or staying asleep

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• rash
• fever
• swelling of the eyes, face, lips, tongue, mouth, or throat
• hives
• difficulty breathing or swallowing
• hoarseness or throat tightness

Atovaquone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not freeze this medication.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo. gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• rash
• grey-bluish color of lips and/or skin
• headache
• tiredness
• shortness of breath

• Mepron^®

Last Revised – 11/15/2017

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Atovaquone and Proguanil: MedlinePlus Drug Information

pronounced as (a toe’ va kwone)

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The combination of atovaquone and proguanil is used to treat a certain kind of malaria infection (a serious infection that is spread by mosquitoes in certain parts of the world and can cause death) and to prevent a certain kind of malaria infection in travelers who visit areas where malaria is common. Atovaquone and proguanil is in a class of medications called antimalarials. It works by killing the organisms that cause malaria.

The combination of atovaquone and proguanil comes as a tablet to take by mouth. If you are taking atovaquone and proguanil to prevent malaria, you will probably start taking it once daily 1 or 2 days before you travel to an area where malaria is common, and then continue during your time in the area and for 7 days after you return. If you are taking atovaquone and proguanil to treat malaria, you will probably take it once daily for 3 days in a row. Always take atovaquone and proguanil with food or a milky drink. Take atovaquone and proguanil at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atovaquone and proguanil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you have trouble swallowing the tablets, they may be crushed and mixed with condensed milk just before taking them.

If you vomit within 60 minutes after you take atovaquone and proguanil, take another full dose.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking atovaquone and proguanil,

• tell your doctor and pharmacist if you are allergic to atovaquone and proguanil, any other medications, or any of the ingredients in atovaquone and proguanil tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven), indinivir (Crixivan), metoclopramide (Metozolv, Reglan), rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate, in Rifater), and tetracycline (Sumycin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with atovaquone and proguanil, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you have kidney disease. Your doctor may tell you not to take atovaquone and proguanil.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking atovaquone and proguanil, call your doctor.
• you should know that atovaquone and proguanil decreases your risk of becoming infected with malaria but does not guarantee that you will not become infected. You still need to protect yourself from mosquito bites while you are in an area where malaria is common by wearing long sleeves and long pants and using mosquito repellant and a bed net.
• you should know that the first symptoms of malaria are fever, chills, muscle pain, and headaches. If you are taking atovaquone and proguanil to prevent malaria, call your doctor immediately if you develop any of these symptoms. Be sure to tell your doctor that you may have been exposed to malaria.
• you should plan what to do in case you experience serious side effects from atovaquone and proguanil and have to stop taking the medication, especially if you are not near a doctor or pharmacy. You will have to get another medication to protect you from malaria. If no other medication is available, you will have to leave the area where malaria is common, and then get another medication to protect you from malaria.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Atovaquone and proguanil may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• diarrhea
• stomach pain
• loss of appetite
• headache
• dizziness
• cough
• mouth sores

Some side effects can be serious.

If you experience any of these symptoms, call your doctor immediately:

• rash
• hives
• peeling or blistering skin
• fever
• swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles or lower legs
• difficulty breathing or swallowing
• hoarseness or throat tightness
• yellow eyes or skin, dark urine, loss of appetite, fatigue, or pain or discomfort in right upper stomach area

Atovaquone and proguanil may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• rash
• grey-bluish color of lips and/or skin
• headache
• tiredness
• shortness of breath
• vomiting
• stomach pain or discomfort
• hair loss
• dry, cracked skin on palms of hands or bottom of feet
• canker sores

• Malarone^®

Last Revised – 05/15/2019

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Atovakvon – instructions for use

Atovaquone

Instruction:

• Pharmacological action
• Pharmacokinetics
• Readings
• Contraindications
• Pregnancy and breastfeeding
• Dosage and Administration
• Side effects
• Classification

Pharmacological action

Atovaquone (atovachone) is a synthetic antiprotozoal agent derived from hydroxynaphthoquinone. The mechanism of action is not fully understood. Pneumocystis, babesia, toxoplasma, malarial plasmodium and microsporidia are sensitive to atovaquone. Atovaquone is less effective than other antiprotozoal drugs in Pneumocystis pneumonia but has fewer side effects.

Pharmacokinetics

Atovaquone is poorly absorbed when taken orally, the bioavailability of the drug increases during meals. With a high-fat meal, bioavailability is 47%. Atovaquone binds well to plasma proteins, the drug is well distributed in most tissues of the body, but does not pass well through the blood-brain barrier, there are no data for penetration through the placental barrier and excretion into breast milk. The drug is metabolized by enterohepatic circulation. Eliminated from the body mainly with feces, partially excreted in the bile, in small amounts (about 1%) excreted in the urine. Half-life (T _½ ) is 2.2–2.9 days, during which time it does not increase with renal and hepatic insufficiency.

Indications

Pneumocystis pneumonia, with intolerance to TMP/MSK.

Contraindications

Hypersensitivity to the drug.

Pregnancy and lactation

Pregnancy

FDA fetal category C.

There are no adequate and well-controlled safety studies of the use of atovaquone in pregnant women.

Animal studies have shown signs of increased resorption and fetus.

Atovaquone is contraindicated during pregnancy.

Use during breastfeeding

It is not known whether atovaquone is excreted in human breast milk.

Experimental studies have shown penetration of atovaquone into the milk of lactating rats.

Breast-feeding should be discontinued during treatment.

Dosage and administration

Orally (by mouth).

Adults: 750 mg twice daily with food for 21 days.

Children: 40 mg/kg/day.

Side effects

Often (up to 20% of cases) skin rash, diarrhea, nausea, vomiting infrequently headache, sleep disturbance, fever, increased activity of aminotransferases in the blood, anemia, neutropenia.

Classification

• ATX

  P01AX06

• Pharmacological group

  Other synthetic antibacterials

• ICD code 10

  B59 Pneumocystosis

• FDA pregnancy category

  C
  (risk not excluded)

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Learn more about the active substance Atovaquone:

• INN
• Reviews
• Questions
• Latin name
• Chemical formula

Information about the active substance Atovaquone is intended for medical and pharmaceutical professionals, for reference purposes only. The instructions are not intended to replace professional medical advice, diagnosis or treatment. The information contained here may change over time. The most accurate information on the use of preparations containing the active substance Atovaquone is contained in the manufacturer’s instructions attached to the package.

Instructions for Use ATOVAQUONE for Dogs, Cats

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Use of Atovaquone (ATOVAQUONE) in veterinary medicine

• Atovaquone (ATOVAQUONE)
• Therapeutic Grade – Antiprotozoal
• Animal species – dogs and cats
• May be prescribed by veterinarians for the treatment of dogs infected with Gibson Babesia
• Cats are used for: Cytauxzoon Felis.
• Trade name: Malarone®.

Basic information

According to the instructions for use, atovaquone is a broad-spectrum antiprotozoal drug. Its mechanism of action is to suppress mitochondrial electron transfer in the parasite. The drug “Atovaquone” is used in human medicine in combination with azithromycin for the treatment of invasion by Asian strains of Babesia. It has a favorable safety profile and appears to have fewer reported adverse reactions than some of the standard animal treatments for babesiosis. Atovaquone is also used in human medicine as an antimalarial drug in the combination drug Malarone®.

Atovaquone in dogs and cats

Atovaquone in combination with azithromycin is a promising new treatment for Babesia gibsoni in dogs. Babesia is a protozoan parasite that lives in the red blood cells of mammals and is a disease that occurs in many parts of the world. B. gibsoni infestations are currently widespread in the United States, Asia. There are two forms of piroplasm that can infect dogs:

• large babesia (2-4 x 4-7 µm)
• small babesias (1.1-2 x 1.2-4 µm)

B. gibsoni is a small babesia, as is Babesia microti, a piroplasm species that causes parasitic disease in humans.

Most cases of B. gibsoni found in the United States occur in the Bull Terrier population or in dogs that have been bitten by or fought with a Bull Terrier. The natural vectors of B. gibsoni are ticks and ticks Rhipicephalus sanguineus. Vertical transmission of B. gibsoni can also take place. The clinical manifestation of invasion is most often found in young animals.

Canine infestations caused by B. gibsoni piroplasms are difficult to treat with imidocarb diproprionate. Although controlled studies have not been published, the combination of atovaquone with azithromycin may improve the rate of recovery and is thought to cause fewer adverse reactions. One author states that 50% of treated animals become PCR negative after six weeks.

Atovaquone in combination with azithromycin is also used to treat cats infected with Cytauxzoon felis. C. felis is a serious tick-borne protozoal disease of cats. Although there are no controlled studies yet, preliminary work using atovaquone and azithromycin suggests a survival increase of over 60%. The success rate for treating C. felis with imidocarb was much less than 50%.

Learn about essential antimicrobials in animals

• Trichopol for animals
• Baytril Veterinary Instructions for Use
• Metronid (Metronid) for animals (instructions for use, doses, indications and contraindications)
• Instructions for use of ceftriaxone in veterinary medicine (Ceftriaxone). Examine the breadth of the antibacterial effect of ceftriaxone in animals
• Examine the breadth of the antibacterial effect of metrogil in animals
• Instructions for use of doxycycline in animals. Examine the breadth of the antibacterial effect of doxycycline in animals. Calculate the optimal dose of the drug f-th of different types
• Metronidazole (Metronidazole) for animals (instructions for use in veterinary medicine, doses, indications and contraindications)
• Azithromycin for animals

Treatment of cats

Eighty cats with acute cytauxoonosis from various veterinary clinics in five endemic states participated in this study.

After diagnosis, each cat was randomly assigned to one of two treatment groups. One group was treated for 10 days with atovaquone (15 mg/kg orally three times a day) and azithromycin (10 mg/kg orally once a day). Cats in the imidocarb group were pretreated with subcutaneous atropine and 15 minutes later received an intramuscular injection of imidocarb dipropionate at a dose of 3.5 mg/kg. The injection procedure was repeated seven days later. Treatment by veterinarians was provided to provide supportive care and other related treatments.

The results showed that 60% of cats treated with the atovaquone-azithromycin combination survived compared to only 26% of the imidocarb treated group. Another interesting finding was that regardless of treatment, cats with lower parasitemia survived more often, as did cats with higher white blood cell counts and lower total bilirubin concentrations. However, the authors of this study caution that, due to the small size of the study, these parameters cannot be used as predictors of prognosis. The results also showed that the cats were infected with different pathogen genotypes, and several individuals were infected with several isolates.

The results of this study show that treatment with atovaquone and azithromycin improves survival to discharge in cats with acute cytauksoonosis, although mortality remains high. As the authors note, the high mortality rate associated with this infection should encourage veterinarians to focus their efforts on prevention by minimizing cats’ exposure to ticks.

Therapy in dogs

To irradiate imidocarb-resistant babesia strains in dogs, atovaquone 13.3 mg/kg po q 8 hours and azithromycin 10 mg/kg po once a day , both drugs for 10 days.

Side effects

No information was found in the literature on the side effects of the combination of atovaquone and azithromycin in animals. Malarone (atovaquone in combination with proguanil hydrochloride) should not be used in dogs due to the high incidence of gastrointestinal side effects.