Specific treatment of canine babesiosis consists of antibabesial drugs and, in severely anaemic animals, blood transfusion. Supportive therapy is also required, particularly in animals with complicated disease. Strategies for treatment of uncomplicated and complicated babesiosis are discussed. Definitive recommendations cannot be provided on the basis of available information, but suggestions are made, based on accepted therapeutic principles, pathophysiological mechanisms, therapy used in human malaria, and clinical experience. The problems of fluid therapy in complicated babesiosis, particularly in animals with oliguria, cerebral babesiosis and pulmonary oedema, are presented, with consideration given to the use of hypertonic fluids. The benefits of bicarbonate and alternative alkalinisers in life-threatening lactic acidaemia, a relatively common occurrence in complicated babesiosis, are debated, as are the benefits of oxygen therapy in anaemic hypoxia. Drug therapy and management of specific babesial complications are discussed. The rationale for supportive drugs commonly used in uncomplicated babesiosis, including lipotropic agents, haematinics and glucocorticoids, is examined. This review is designed to propose therapeutic guidelines and to stimulate interest in problematic aspects of supportive therapy for canine babesiosis.