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Treatment approaches will depend on the disease status of a country and whether a country has endemic disease. In some endemic countries, treatment may be aimed at reducing the severity of clinical signs and preventing fatalities, but it may not be advised to treat ‘carrier horses’ as a low level of infection may be deemed to be protective in preventing severe acute disease, as horses will have continued re-exposure from infected ticks.

Treatment in a non-endemic country such as the UK is applied with the intention of complete clearance of infection, although this may not be readily achievable with currently available treatments. There is no licensed treatment for piroplasmosis, but off-license use of antiprotozoal agents has been reported, with varying success at clearing infection.