Finished? And How to Prevent Relapse

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The End of a Lyme disease treatment image from Marty Ross MD

Rewritten and Updated: 7/2/2024

Cure versus Remission

It is possible to cure chronic tick-borne infections like Borrelia (Lyme), Babesia, and Bartonella. But for many, treatment with herbal or prescription antibiotics does not eradicate the germ, it only lowers the germ load enough to put people in remission. In remission, the infections remain, but the immune system keeps the germ load under control. 

If a person can remain symptom free for two years after treatment, it is safe to say they are cured. I say this based on my twenty years of experience treating tick-borne infections and lack of seeing relapses in people who made the two year symptom free mark. But to be clear, we do not have any testing we can do to prove Lyme and tick-borne disease treatment wipes out the germs completely. 

The Lyme & Tick-borne Disease Done Test

I wish there was a done test in Lyme, Bartonella and Babesia, but there is not. For more about this see Repeat Lyme & Coinfection Testing to Check Treatment Status Is Not Valid

When I first started treating chronic tick-borne infections, many of my colleagues promoted an idea that a person would not relapse at the end of treatment if two conditions were met. First, a person had to be symptom free for 2 months. Second, the CD-57 test had to be in a normal range of at least 150 or higher. So the CD-57 looked like it could be the done test.

The CD-57 is a type of white blood cell that is often low in those with immune suppression caused by Lyme disease. If it is normal at the end of treatment it indicates that there is no immune suppression. What I learned through my own observations over the years is that even with normal CD-57 counts and having no symptoms at the end of treatment, many will eventually relapse years down the road. In fact the level of the CD-57 test does not predict how quickly a person will relapse.

Active Treatment is Done

I now consider active infection treatment "finished" in two separate situations. A person's treatment is complete when

  • they are symptom free of Lyme disease for two months, or
  • if they are at a plateau for 4 or more months and no changes in his or her treatment protocol moves the treatment forward. Before I declare there are no further treatments or supports that could help, I try many of the options in Can't Get Better? Do This.

I no longer test the CD-57 because I do not think it accurately predicts anything.

Relapse Prevention Steps

I suggest doing each of the following prevention steps simultaneously as you stop active treatment.

Step 1. Preventive Herbal Antibiotics to Suppress Germ Load

When a person's treatment is "finished" I suggest one of three different preventive antibiotic courses. The foundation of all three choices is to support the immune system vigorously. More on this later. The three choices are:

  • wait and see if relapse occurs while supporting the immune system,
  • use preventive herbal antibiotics, and
  • use preventive prescriptive antimicrobials.

In the wait and see approach I advise a quick return visit if any Lyme disease, Bartonella or Babesia symptoms return. My experience for those that choose this option is that if Lyme, Bartonella or Babesia become active, a course of antibiotics or herbal anti-microbials quickly turns things around. People usually do not go back into the "hole" of the disease, but rather have a return to health within weeks to a few months.

In the preventive antimicrobial approaches, I use herbs or prescriptive antimicrobials in a more limited way than while under full treatment to police the body and to keep the remaining Lyme germs under control. In using antimicrobials this way, I treat Lyme, Bartonella, or Babesia as I would other chronic infectious conditions like HIV disease where people do quite well as long as they take antivirus drugs to keep the germ-load down.

Here are some sample relapse prevention herbal antibiotics I have used.

  • Borrelia (Lyme): Cat's Claw and Otoba Bark 15 drops of each 2 times a day
  • Bartonella: Houttuynia and Sida Acuta 15 drops or each 2 times a day
  • Babesia: Cryptolepis 2.5 ml 3 times a day

For alternative herbal antibiotic regimens that can address one or more of the three Bs at the same time see Best Herbal Antibiotic Plans for Lyme, Bartonella, and Babesia. (Dose Quantity: Decrease the quantity I recommend per dose in this article by 1/2 the amount for relapse prevention purposes.)

I prefer to use herbal antibiotics over prescription antibiotics in relapse prevention because the herbals tend not to disturb a healthy intestinal microbiome. 

Step 2. Rehab The Intestinal Microbiome

The intestinal microbiome is the mastermind behind a healthy immune system.

Take steps to feed healthy intestinal bacteria combined with using probiotics and postbiotics. For the rationale behind these actions read Your Guide to a Healthy Intestinal Microbiome—Even on Antibiotics for more information.

Feed Your Intestinal Microbiome with Polyphenols and Prebiotic Fibers

Polyphenols, prebiotic non-digestible fibers and sugar support a healthy gut microbiome. Make sure you build these into your gut health action plan. My preference is to get the polyphenols and prebiotic fibers in your diet, but I realize that is not always possible, especially if it is too hard to cook due to illness.

Option 1. Use Supplements

  • Polyphenol 2 capsules one time a day. I prefer Polyphenol Booster by Pendulum.*
  • Prebiotic non-digestible sugars 1 to 2 pills 3 times a day. I prefer MegaPre by Multibiome Labs.*

Option 2. Eat a Plant-forward Whole Food Diet

  • Include polyphenols and prebiotic plant fibers in your diet by eating a whole food diet rich in colorful berries and fruits, vegetables, beans, legumes, nuts and seeds. Aim for at least 30 grams of plant-based fiber a day which you can track using an app like MyFitnessPal or by having at least 5 servings a day of the various foods types listed above. In choosing a whole-foods plant-forward diet, it is ok to use animal proteins or plant-based proteins for your protein source.

Use Postbiotics and Probiotics

It is important to rebuild a healthy gut at the end of a prolonged antibiotic treatment. I suggest using this probiotic-postbiotic option for six months to a year. There is no research that backs how long to do this. My observation in my practice using just probiotics, is that the best results for intestinal microbiome health can take 6 months or more to return.

  • Postbiotic supplement 1 pill 1 to 2 times a day with food. The only postbiotic supplement on the market is Thaenabiotic.* This product is only available through healthcare providers who must have visits with you. Thaena is considering ecommerce sales without provider involvement in the future. When that happens, we plan to carry the product at Marty Ross, MD Supplements.
  • Akkermansia, Bifidobacterium, Anaerobutyricum hallii, Clostridium beijerinckii, and Clostridium butyricum blend 1 pill 2 times a day. I prefer the Metabolic Daily product by Pendulum.*

One other option instead of using the probiotic-postbiotic option above is to have a Fecal Microbiota Transplant (FMT).

  • FMT from a family household member or another person with a similar intestinal microbiota. As I noted earlier in this article, FMT to rehab the gut is only allowed by the FDA in an experimental setting. FDA only allows FMT to treat C. difficile diarrhea, but not other conditions. If you are interested in pursuing this further, consider a visit with Dr. Sabine Hazan through one of her programs at Progenabiome.

Comment: It is best to have your donation from a healthy family or household member because their intestinal microbiota is most likely to be similar to a healthy microbiome you would have had if not for tick-borne disease and antibiotics. FMT from random donors may have a variety of microbiota organisms that are not like those you would have in a healthy situation.

Step 3. Support The Immune System to Prevent Relapse

Although the to-do or not-to-do antimicrobials discussion is important, what is most important at the end of treatment is to support the immune system. So I recommend, whether a person uses antimicrobials or not, the following actions.

  • regular sleep of seven or more hours a night;
  • regular exercise as long as it does not make a person worse;
  • continuing emotional detoxification;
  • a plant forward organic diet to limit toxins that can suppress the immune system and to promote a healthy intestinal microbiome;
  • a good multi-vitamin that provides all of the essential nutrients the immune system requires; 
  • immune system support with
    • a multi-immune mushroom formula 1 pill 3 times a day like The Immune Builder 5 Mushroom Formula by Mushroom Science* or 
    • targeted transfer factors against Lyme germs like Transfer Factor L-Plus by Researched Nutritionals* 1 pill 2 times a day. Read Transfer Factors: Turn On The Army for more information. 


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

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