Kills Babesia: A Brief Guide

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How to Treat Babesia in Lyme Disease Image from 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 supports the combination of atovaquone and azithromycin. There is also research support for the clindamycin and quinine combination. These studies support a seven- to ten-day course of treatment. This is one reason why many insurers refuse to pay for Babesia treatments longer than ten 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 four to five 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—it is possible to cure Babesia 95 percent of the time, in my experience. This means five percent of people may relapse 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 ten steps in The Ross Lyme Support Protocol. These steps may

  • 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. Therefore, treating Babesia requires using 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. Curing 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 one to two 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 percent of the time based on my experience. Dosing is for adults. All of the tier one approaches are prescription medicines.

Atovaquone/Proguanil Combinations

Atovaquone/proguanil (Malarone) 250 mg/100 mg. Start the atovaquone/proguanil 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 four-drug regimen. (Atovaquone/proguanil (Malarone) has two drugs in one pill).

Atovaquone Combinations

Atovaquone (Mepron) 750 mg/5 ml, take 5 ml two times a day. In one to two 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 four-drug regimen. (Atovaquone/proguanil (Malarone has two drugs in one pill).

Be sure to take atovaquone with fat because 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 percent 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 that it does not work if it is used continuously.)

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 second day and sometimes lasting until six 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/proguanil, 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/proguanil (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 supports Babesia removal about 75 percent of the time. Take it as 5 ml 3 times a day. In addition to using cryptolepis to treat active Babesia, 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 three antimalarial herbs that support Babesia removal. Take 5 ml 3 times a day. 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 second and third 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 two, three, or four 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 Babesia Treatment in Lyme Disease

I call these the "if all else fails" approach. Generally, it is effective about 75 to 85 percent of the time. Clindamycin/Plaquenil/Quinine work, but they have many side effects that make them hard to take.

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 people due to side effects. Hydroxychloroquine is a Quinine-like medication that is easier to tolerate than the Quinine Sulfate, though 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.

Nitazoxanide (Alinia)

I use to include nitazoxanide (Alinia) in this group. However, overtime in my Seattle practice I found it to rarely work. Therefore I no longer consider it a treatment option. For more information see Alinia: When & Why in Lyme Disease Treatment.

Relapse Prevention

In my experience, it is possible to cure Babesia in Lyme disease 95 percent 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/proguanil 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.

Disclaimer

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.

References

View Citations

  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. Infect Dis Clin North Am. 2008;22(3):469-ix. doi:10.1016/j.idc.2008.03.010.

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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 where he treated thousands of Lyme disease patients in his Seattle practice through late 2018. 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) and The Institute for Functional Medicine.

Marty lives with his two beloved Basenji dogs in Austin, Texas. There he enjoys the hot humid weather, friends, food trucks, exercise, organic food, live music, whiskey, and long Texas Hill Country motorcycle rides.

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