Active Engines
✓ Tafenoquine + Azithromycin
Week 2 — correct combination direction
⚠ G6PD UNTESTED — CRITICAL
Italian heritage + 8-aminoquinoline = mandatory screen
✓ Merozoite oscillator 48-72h
Watch day 3-5: peak temp trending down = working
⚠ Haemolytic load
Monitor haematocrit daily + urine colour (dark = stop Tafenoquine)
⚠ Atovaquone resistance risk
5wk mono → Tafenoquine overlap. Day 7 parasitaemia = verdict
✓ CNS recovery trajectory
Improving IF oscillator 1 controlled. Watch lucidity daily.
⚠ Drug Interactions
HIGH · tafenoquine + G6PD deficiency (untested)
14-19d half-life — haemolysis persists weeks. Italian heritage = Mediterranean variant risk (Class II, severe).
MEDIUM · tafenoquine + atovaquone-resistant Babesia
Mitochondrial mechanism overlap — possible partial cross-resistance. Day 7 smear is the test.
MEDIUM · azithromycin + tafenoquine + QT prolongation
Both extend QT. ECG if available. Avoid other QT-prolonging drugs.
Protocol
Tafenoquine (current)
300mg/week maintenance · Continue if G6PD normal
STOP IMMEDIATELY if dark urine appears. 14-19d half-life — cannot be reversed.
Azithromycin (current)
500mg/day · 10-14 days minimum
Correct. Independent mechanism. Safe in G6PD deficiency. Keep even if Tafenoquine stopped.
G6PD test — TODAY
Blood test · Immediate
FDA-mandatory before Tafenoquine. If not done: watch for dark urine hours 48-72. Hospital if seen.
Haematocrit check
Daily CBC · Daily this week
Track: target >28%. Falling Hct without fever = G6PD haemolysis, not Babesia.
Day 7 parasitaemia check
Blood smear · Day 7
Parasitaemia <1% = treatment working. Parasitaemia unchanged = switch to Clindamycin+Quinine.
Escalation: Clindamycin+Quinine
600mg Q6H + 650mg Q8H · If day 7 fails
Gold standard for resistant Babesiosis. Different mechanism — no cross-resistance.