Kills Babesia: A Brief Guide.

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The best herbs and prescriptions to kill babesia in a Lyme disease treatment image from Marty Ross MD

" I updated this article on August 7, 2018. See new information about artemesinin, CSA tinctures, chances of recovery, and the science behind successful Babesia treatments in Lyme Disease."

Marty Ross MD

 

Babesia Treatment in Lyme Disease

In my experience, recovering from babesia, one of the Lyme disease co-infections, requires

  • combination herbal or prescription antibiotics and antimalarials,
  • steps to boost the immune system, and
  • supplements to decrease inflammation caused by chemicals called cytokines.

Limited research shows prescription antimalarials work for babesia. Research exist for the combination of atovaquone and azithromycin. There is also research on clindamycin and quinine. These studies support a 7-10 day course of treatment. This is one reason why many insurers refuse to pay for babesia treatments longer than 10 days.

However, there are no studies about Babesia treatment in Lyme. In Lyme, the experience of most experienced Lyme Literate Medical Doctors is that it can take 4-5 months of continuous antimicrobials for babesia to resolve.

In clinical practice, many different combinations of herbal and prescription antimalarials work to cure babesia. I explain these various combinations below. With these treatments, including steps to boost the immune system and to decrease inflammation, in my experience, it is possible to cure Babesia 95% of the time. This means 5% of people may have relapses, or require treatments involving a number of the different approaches below.

Boost the Immune System to Cure Babesia

It is critical for babesia recovery to take steps that boost the immune system. Boost the immune system following the first 10 steps in The Ross Lyme Support Protocol. These steps

  • correct sleep,
  • decrease inflammation cytokines,
  • help the immune system adapt to stress,
  • correct hormone imbalances,
  • provide essential micronutrients, and
  • remove yeast overgrowth in the intestines if present.

Use Combination Antimalarials to Cure Babesia

Babesia is a blood parasite like the parasite that causes malaria. To treat it, use combinations of antimicrobials that are also used to treat malaria. Generally treatments require four to five months. This length of time is required due to immunosuppression caused by Lyme. To cure babesia requires treating at least one month longer than the average length of time a red blood cell lives after it is made by the bone marrow in the center of bones. A red blood cell lives for around three months.

As I noted above, there is no useful science to guide treatment decisions for babesia in someone who has Lyme. What follows is based on my experience treating babesia in Lyme disease.

In general, if a treatment is working, the symptoms of babesia should start to improve in 1 to 2 months. If they do not start to improve, then change to a different regimen. Read more about babesia symptoms in It Could Be Bartonella or Babesia: The Symptoms and Signs.

Tier One Babesia Treatments in Lyme Disease

The following approaches work about 85% of the time based on my experience. Dosing is for adults. All of the tier one approaches are prescription medicines.

Atovaquone/Proguanil Combinations

Atovaquone/proquanil (Malarone) 250 mg/100 mg. Start the atovaquone/proquanil at 2 pills 2 times a day for 3 days, and then decrease to 1 pill 2 times a day. Combine it with one of the following:

  • azithromycin (Zithromax) 500 mg 1 time a day,
  • clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
  • doxycycline 100 mg 2 pills 2 times a day, or
  • minocycline 100 mg 1 pill 2 times a day.

In addition, if these combinations are not working, add

  • sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone) has two drugs in one pill).

Atovaquone Combinations

Atovaquone (Mepron) 750 mg/5 ml, 5 ml two times a day. In 1 to 2 months if night sweats or other babesia symptoms are not improving, then increase the dose to 10 ml two times a day. Combine it with one of the following:

  • azithromycin (Zithromax) 500 mg 1 time a day,
  • clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
  • doxycycline 100 mg 2 pills 2 times a day, or
  • minocycline 100 mg 1 pill 2 times a day.

In addition, if these combinations are not working, add

  • sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone has two drugs in one pill).

Be sure to take atovaquone with fat. This increases its absorption. Take enough fat so the medicine does not cause nausea or diarrhea. Sources of fat include nuts, nut butter, butter, oils like coconut oil and flaxseed oil, yogurt, cheeses, and avocado.

Tier Two Babesia Treatments in Lyme Disease

The following regimens work 75 to 80% of the time based on my experience. Dosing is for adults.

Artemisinin

(Note: I understand the herbalist Buhner, no longer recommends this medication. However I still find it very useful using the dosing I recommend below. I do agree with Buhner, if it is used continuously, it does not work.)

Artemisinin 100 mg is an herbal medication. Start at 2 or 3 pills 2 times a day for 3 days on the medication, then take 11 days off. Continue this 14 day cycle. The goal is to reach 5 pills 3 times a day on the 3 days the medication is taken. I use artemisinin this way to overcome resistance. Be aware, the dose on the 3 days is quite strong. Often it causes a worsening of the babesia symptoms beginning on the 2nd day and sometimes lasting until 6 days later. If a person is very medicine sensitive, I start at 1 or 2 pills 3 times a day.

Artemisinin resistance can occur for two reasons. First, the liver learns to clean artemisinin out more quickly after a person is on it for a few days. The other mechanism could be similar to what happens in Malaria. In Malaria, partial resistance develops in the germ after a few days. In Malaria, it is shown that artemisinin works best by pulsing on and off the drug like I recommend above.

It is possible to combine artemisinin with atovaquone, atovaquone/proquanil, or mefloquine if the artemisinin is not working well enough.

Mefloquine Combinations

Mefloquine (Lariam) 250 mg is a prescription medication. Start at 1 pill daily for 5 days, and then take as 1 pill every 5 days. It may cause nausea on the first five days. Mefloquine dissolves and is stored in fat. It takes 5 days or longer to saturate or to fill up the fat. Once the fat is saturated, taking a pill every 5 days keeps the fat saturated.

Combine it with one of the following:

  • azithromycin (Zithromax) 500 mg 1 time a day,
  • clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
  • doxycycline 100 mg 2 pills 2 times a day, or
  • minocycline 100 mg 1 pill 2 times a day.

In addition, if these combinations are not working, add

  • sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone has two drugs in one pill).

This medication is the most affordable option. In the US mefloquine is about $70 a month. However it can have significant mental health side effects like depression and hallucinations or even psychosis. I only use it if there are no other affordable options for my patients.

Cryptolepis

Cryptolepis is an herbal medicine originally used in Ghana to treat malaria. It works about 75% of the time. Take it as 5 ml 3 times a day. In addition to using Cryptolepis to treat active babesia I sometimes will use it as a preventive medication in a person who has a babesia relapse. See the relapse section below.

Cryptolepis/Sida Acuta/Alchornea (CSA Tincture)

Cryptolepis/Sida Acuta/Alchornea combines 3 antimalarial herbs. Take 5 ml 3 times a day. I will use this if the Cryptolepis alone is not working well enough.

Artemether/lumefantrine

Artemether/lumefantrine 20 mg/120 mg (Coartem) is a prescription medication. Take 4 pills 2 times a day for 3 days. On the first day take the second dose 8 hours after the first dose. On the 2nd and 3rd day, take each dose 12 hours apart. The 1st dose of the day on all three days should be at the same time. Coartem can be repeated every 2, 3 or 4 weeks. I suggest starting every 2 weeks, and increase the time between each cycle as long as symptoms do not return on the off medicine days.

Tier Three

I call these the "if all else fails" approaches. I use these approaches for various reasons. Generally, each is effective about 75 to 85% of the time. The Nitazoxanide is in this group because if it is quite expensive and often insurance will not pay for it. Without insurance it costs around $1400 a month. And Clindamycin/Plaquenil/Quinine work, but they have many side effects that make them hard to take.

Nitazoxanide

Nitazoxanide 500 mg (Alinia) is a prescription medication is approved for the treatment of intestinal parasites. However it seems to help with babesia as well. Take 1 pill 2 times a day. In the US it is sold as a brand only medication. In Canada it is made only at compounding pharmacies, but it does not seem as effective as the brand version.

Clindamycin and Hydroxychloroquine

Clindamycin 300 mg (Cleocin) and either Hydroxychloroquine 200 mg (Plaquenil) or Quinine Sulfate 324 mg is an old time combination that can treat Babesia. However it is very hard to tolerate for most due to side effects. Hydroxychloroquine is a quinine-like medication that is easier to tolerate than the Quinine Sulfate. However, Quinine sulfate may be more effective.

Side effects of Clindamycin that make it hard to tolerate include: nausea, diarrhea, abdominal pain, and allergic type reactions. Quinine Sulfate can cause ringing in the ears, but can also cause muffled hearing and other severe neurologic conditions. Generally as a quinine-like medication plaquenil does not seem to cause these problems.

  • Option 1. Clindamycin 300 mg 2 pills 3 times a day and Quinine Sulfate 324 mg 2 pills 2 times a day. If muffled hearing or other neurologic symptoms other than ringing in the ears develop then decrease the quinine sulfate to 1 pill 2 times a day.
  • Option 2. Clindamycin 300 mg 2 pills 3 times a day and Plaquenil 200 mg 1 pill 2 times a day.

Relapse Prevention

In my experience, it is possible to cure babesia in Lyme disease 95% of the time. However, a number of people do relapse or may not ever be able to stop medications. If a person recovers from babesia, but then relapses after the germ is under control with one of the above regimens, then try a preventive regimen.

  • Option 1. Atovaquone/Proquanil 250 mg/100 mg (Malarone) 1 pill daily.
  • Option 2. Cryptolepis 5 ml 3 times a day for 2 or 3 weeks on of each 4 weeks. Find the frequency that works best.
  • Option 3. Artemisinin 100 mg 2 or 3 pills 3 times a day for 3 days in a row of each 14 days. Repeat this cycle continuously.

References

  1. Buhner SH. Natural Treatments for Lyme Coinfections: Anaplasma, Babesia, and Ehrlichia. Rochester, VT: Healing Arts Press; 2015.
  2. Vannier E, Gewurz BE, Krause PJ. Human Babesiosis. Infectious disease clinics of North America. 2008;22(3):469-ix. doi:10.1016/j.idc.2008.03.010.

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