Kills Bartonella: A Brief Guide.

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How to kill bartonella in a Lyme disease treatment image from Marty Ross MD

"I updated this article on August 10, 2018. It includes new information about Rifamycin, Bactrim, and Flouroquinolone treatment plans. I also added scientific references."

Marty Ross MD

Bartonella Treatment in Lyme Disease

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

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

There is limited research showing what antimicrobials work best for bartonella. These are petri dish experiments that show intracellular antibiotics, ones that get inside of cells, work best. The antibiotic treatments I recommend below use these intracellular antibiotics.

However, there are no studies about bartonella treatment in Lyme. In Lyme, the experience of most experienced Lyme Literate Medical Doctors is that it can take 4-6 months of continuous antimicrobials for bartonella to resolve.

In clinical practice, many different combinations of herbal and prescription antibiotics work to cure bartonella. 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 bartonella 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 Bartonella

It is critical for bartonella 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 Antibiotics to Cure Bartonella

Bartonella can be difficult to treat when a person has a borrelia (lyme) infection. To prevent relapse it is best to use two antibiotic combinations. There are three tiers of treatments that I use. Tier One and Two include prescription antibiotics; Tier Three is an herbal antimicrobial combination. The most effective treatments are in Tier One followed by Tier Two. I tend to use Tier Three when a person cannot tolerate prescription antibiotics or when the prescriptions do not work. Tier One combinations appear to work 90% of the time and tier two about 80% of the time. Tier 3 seems to work 70% of the time or less.

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

In general, if a treatment is working, the symptoms of bartonella 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 bartonella symptoms in It Could Be Bartonella or Babesia: The Symptoms and Signs.

Tier One

Rifamycin-based Treatments

In these treatments Rifampin or Rifabutin is the main effective ingredient. I combine Rifampin 300 mg 2 pills 1 time a day or Rifabutin 150 mg 2 pills 1 time a day with one of the following:

  • minocycline 100 mg 1 pill 2 times a day,
  • bactrim DS 1 pill 2 times a day or
  • azithromycin (Zithromax) 500 mg 1 pill 1 time a day.

Doxycycline 100 mg 1 or 2, 2 times a day can be substituted for the minocycline, but rifampin decreases doxycycline levels in the blood. Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day can be substituted for azithromycin but rifampin also decreases clarithromycin blood levels.

One way to make this treatment stronger is to double the dose of the Rifampin from 300 mg 2 pills 1 time a day to 300 mg 2 pills 2 times a day.

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Bactrim-based Treatments

I combine Bactrim DS 1 pill 2 times a day with either a macrolide or a tetracycline.

Use one of the following macrolides:

  • clarithromycin 500 mg 1 pill 2 times a day or
  • azithromycin 500 mg 1 pill 1 time a day.

Or use one of these tetracyclines:

  • doxycycline 100 mg 1 or 2 pills 2 times a day,
  • minocycline 100 mg 1 pill 2 times a day, or
  • tetracycline 500 mg 1 pill 3 times a day.

Fluoroquinolone-based Treatments

Fluoroquinolones are a class of antibiotics that include a number of members like levofloxacin (Levaquin) and ciprofloxacin (Cipro). I combine levofloxacin 500 mg time a day or ciprofloxacin 500 mg 1 pill 2 times a day with one of the following:

  • minocycline 100 mg 1 pill 2 times a day,
  • doxycycline 100 mg 1 to 2 pills 2 times a day, or
  • bactrim DS 1 pill 2 times a day.

Clarithromycin and azithromycin are not used with fluoroquinolones because together they may cause heart rhythm problems. Levofloxacin seems stronger than the ciprofloxacin.

I use Fluoroquinolone-based treatments as a last resort. I do this because they occasionally can cause permanent tendon pain or even breakage.

Tier Two

A Macrolide Plus a Tetracycline

Use one of the following macrolides:

  • clarithromycin 500 mg 1 pill 2 times a day or
  • azithromycin 500 mg 1 pill 1 time a day.

Combine these with a tetracycline:

  • doxycycline 100 mg 1 or 2 pills 2 times a day,
  • minocycline 100 mg 1 pill 2 times a day, or
  • tetracycline 500 mg 1 pill 3 times a day.

Tier Three

Houttuynia plus Sida Acuta

I started using these two herbs together in the summer of 2015. This combination works about 70% of the time. Start houttuynia at 5 drops 2 times a day and increase daily by 1 drop per dose till at 30 drops 2 times a day. At the same time take Sida Acuta 1/4 tsp 3 times a day and after 1 week if tolerating it increase to 1/2 tsp 3 times a day.

Prior to using this combination I was not impressed with other herbal options. For instance I have tried a formula called A Bart by Byron White herbs which seems to help less than 50% of the time. Likewise houttuynia by itself only works 50% of the time.

Treatment Course

For most of the combinations described above, treatment requires 4-6 months. The only exception to this is a treatment which includes levofloxacin which typically requires 1 to 3 months. I treat until most of the bartonella symptoms go away. Fortunately, using the immune supports and tier one or two approaches 95% of people recover from bartonella. The remaining 5% may have relapses or require continuous antibiotics to keep bartonella under control. If a person relapses, I find three antibiotic combinations work well.


  1. Buhner SH. Healing Lyme Disease Coinfections. Complementary and Holistic Treatments for Bartonella and Mycoplasma. Rochester, VT: Healing Arts Press; 2013.
  2. Biswas S. Rolain J-M. Bartonella Infection: Treatment and Drug Resistance. Future Microbiol. 2010;5(11):1719-1731.

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For Lyme Disease

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