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Updated: 1/18/23
(Read full Bartonella guide below the video.)
The latest laboratory experiments suggest effective Bartonella treatments must do more than kill growing germ forms—they should also kill hibernating persister forms of Bartonella and include agents to remove biofilms and fibrin nests.
Research published in 2019 and early 2020 is changing the approach I take to treat Bartonella. Previously, research showed Bartonella has rapidly growing germ forms; therefore, the antibiotics I recommended in the past treated growing forms only. New research shows that Bartonella also has non-growing forms called persisters. Think of a persister as a hibernating form of the germ that ignores most antibiotics and immune system attacks. This new research also shows that Bartonella forms protective sugar-slime coverings called biofilms. These biofilms can block the immune system and antibiotics from reaching Bartonella. This new research is based on petri-dish laboratory experiments.
In addition to these key findings, some with chronic Bartonella may require enzymes to break up nests of Bartonella and the blood clotting protein called fibrin that can form in narrow and small blood vessels. These Bartonella nests limit blood flow to tissues and may block antimicrobials and the immune system from killing these germs. Lumbrokinase, a group of enzymes that come from earthworms, is very effective at breaking up fibrin. Other options include nattokinase or serapeptase, but these enzymes are much weaker than lumbrokinase.
In this updated article, I review the best treatment approaches to eradicate Bartonella based on my clinical experience and this new science.
An effective Bartonella treatment may include:
Limited research shows which antimicrobials work best for Bartonella. Existing petri-dish experiments show intracellular antibiotics (ones that get inside of cells) work best. Hence, the antibiotic treatments I describe below use these intracellular antibiotics. The newest research from 2019 and 2020 suggest some intracellular herbal and prescription antibiotics are stronger than others. I review this below.
In my clinical practice, many different combinations of herbal and prescription antibiotics work to cure Bartonella over 4-6 months. With these treatments—including steps to boost the immune system and to decrease inflammation—in my experience it is possible to cure Bartonella 95 percent of the time. This means five percent of people may have relapses or require treatments involving a number of the different approaches below.
Ying Zhang, MD and colleagues at Johns Hopkins show that rifampin and azithromycin are the strongest agents to treat Bartonella. These are followed closely by doxycycline, methylene blue, oregano oil, clotrimazole, and ciprofloxacin. In their experiments, they did not study rifabutin, minocycline, clarithromycin, fluconazole, or levofloxacin. The following combinations of antibiotics are in the same family: rifabutin and rifampin; minocycline and doxycycline; clarithromycin and azithromycin; clotrimazole and fluconazole; and levofloxacin and ciprofloxacin. If one member in a family works well, the other one is likely, too. Therefore, rifabutin, clarithromycin, minocycline, fluconazole, and levofloxacin should work well.
Note that clotrimazole is a topical agent used for vaginal yeast and skin fungus infections. It is not well absorbed in oral forms so is not manufactured in pill form. Fluconazole is an oral agent in the same family that is usually used to treat yeast, but it may work for Bartonella, too.
In a separate experiment with essential oils, Dr. Zhang shows that oregano, cinnamon, and clove oils are effective agents to treat growing and persister bartonella.
Dr. Zhang’s petri-dish research shows methylene blue, oregano oil, and clotrimazole are single agents that work effectively against persister cells. He also shows that the following combinations work very well: azithromycin and methylene blue; rifampin and methylene blue; azithromycin and ciprofloxacin; and rifampin and ciprofloxacin. As I note above, separate research from Dr, Zhang shows oregano, cinnamon, and clove oils are effective agents for persister Bartonella. Additionally, their most recent research shows cryptolepis and Japanese knotweed can treat persister Bartonella and growing Bartonella.
Dr. Zhang’s 2020 study showed that the best combinations for persister Bartonella also are the strongest at removing biofilms. These combinations are: azithromycin and methylene blue; rifampin and methylene blue; azithromycin and ciprofloxacin; and rifampin and ciprofloxacin.
In addition to these combinations, I also find that other biofilm-busting herbal medicines like a combination of oregano oil, cinnamon oil, clove oil; lumbrokinase; the herbs in Biocidin LSF by Biocidin Botanicals; and BioDisrupt by Researched Nutritionals are helpful. You can read more about these in Biofilms: Lyme Disease Gated Communities.
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 are designed to:
Research suggests Bartonella replicates and creates new germs every 24 hours. As a result, Bartonella grows back during any period off antibiotics. Some physicians pulse antibiotics when treating Bartonella. Such regimens can include two weeks taking antibiotics followed by two weeks off. In my practice, I do not find these treatments to work. This is likely due to Bartonella growing back during the period that someone is off the antibiotics.
Bartonella can be difficult to treat when a person has a Borrelia (Lyme) infection. To prevent relapse, it is best to use three antibiotic combinations. There are two tiers of treatments I recommend. Tier One includes prescription and herbal antibiotics. Tier Two is an herbal antimicrobial combination for the person who cannot tolerate prescription antibiotics or when the prescriptions do not work. Tier One combinations appear to work 85-90 percent of the time. Tier Two seems to work 70-75 percent of the time or less.
As I noted previously, there is no useful clinical science to guide treatment decisions for Bartonella in someone who has Lyme. Therefore, 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 one to two months. If they do not start to improve, then change to a different regimen. Read more about Bartonella symptoms in How to Diagnose Bartonella in Chronic Lyme Disease.
Here are some combinations that treat growing and persister Bartonella and target biofilms. In these combinations, I find using three agents work best. I include methylene blue and a combination essential oil product of cinnamon, clove, and oregano to treat persister forms, remove biofilms, and treat growing forms. I list the treatment categories in order of effectiveness and ease of use. This means I find fluconazole-based treatments are slightly stronger than rifamycin-based treatments.
I include methylene blue in its own category and within the fluconazole and rifamycin-based treatments. As a category, I find methylene blue-based treatments to be equal in strength to fluconazole-based treatments. I place the methylene blue category at the bottom of this list due to its cost and due to the mess it creates. Methylene blue costs nearly $350 a month. It also turns urine and stool blue and is very hard to scrub off porcelain toilets. Your clinician will need to order a glucose 6 phosphate dehydrogenase (G6PD) blood test. If this red blood cell antioxidant is low, then you should not take methylene blue. With low G6PD there is a risk that your red blood cells will break apart.
Fluconazole-Based Treatments
Take both of the following agents:
Combine with one of the following antibiotics:
Rifamycin-Based Treatments
Take one of the following rifamycins:
Combine with one of the following macrolides, tetracyclines, or Bactrim:
Combine with one of the following persister agents:
Macrolide and Tetracycline-Based Treatments
Take one of the following macrolides:
Combine with one of the following tetracyclines:
Combine with one of the following persister agents:
Methylene Blue-Based Treatments
Combine with one of the following macrolides or tetracyclines:
About Fluoroquinolone-Based Treatments
Fluoroquinolones are a class of antibiotics that include a number of members like levofloxacin (Levaquin) and ciprofloxacin (Cipro). I no longer use these treatments due to the risk of permanent tendon pain or even breakage.
Houttuynia Plus Sida Acuta Plus Cinnamon, Clove, and Oregano Oil Combo
I started using the houttuynia and Sida acuta together in the summer of 2015. Based on Dr. Zhang’s research, I now include cinnamon, clove, and oregano oil combination pill to treat persisters and biofilms. This combination effectively supports a Bartonella treatment about 70-75 percent of the time.
If someone cannot tolerate the cinnamon, clove, and oregano capsules, then for persisters (and growing Bartonella) I substitute either cryptolepis or Japanese knotweed.
I am not impressed with other herbal options. For instance, I have tried a formula called A-BART by Byron White, which are herbs that seem to help less than 50 percent of the time. Likewise, houttuynia by itself only works 50 percent of the time. I have not had any success using the Beyond Balance herbal products.
At two months into a Bartonella treatment, if there is not significant improvement in Bartonella symptoms supporting the immune system using combination antimicrobials, add lumbrokinase to break apart Bartonella-fibrin nests. I also attack the Bartonella-fibrin nests in any person who has a Bartonella relapse. In this situation, I add lumbrokinase as I restart Bartonella antimicrobials.
For most of the combinations described above, treatment requires 4-6 months. Treat until most of the Bartonella symptoms go away. Fortunately, 95 percent of people recover from Bartonella using the immune supports, Tier One or Two approaches, and possibly lumbrokinase. The remaining five percent may have relapses or require continuous antibiotics to keep Bartonella under control. If a person relapses, three or four antibiotic combinations work well.
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.
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) and The Institute for Functional Medicine.
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