Imidocarb dipropionate is the most effective means of treatment.
Clearance of B. caballi is achieved by the administration of two doses at 2.2 mg/kg im at an interval of 24 hours. It should be administered deep intramuscular and can be associated with severe muscle soreness and local abscessation. Some clinicians recommend splitting the dose and injecting mixed with procaine penicillin into the pectoral muscles.
T. equi is more difficult to treat and parasite clearance requires 4–6 doses at 4 mg/kg at 72-hour intervals. Some clinicians will decide to administer a lower dose and allow the horse to develop immunity to the parasite, especially if in an endemic area. Parasite clearance becomes of greater concern in competition horses required to test negative for international travel.
Imidocarb is an anticholinesterase and treated horses should be carefully monitored for associated side effects such as colic and hypersalivation. Donkeys are particularly sensitive to imidocarb and should not receive the higher dose.