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updated 6/24/20
“New experiments show 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.”
Marty Ross MD
Recent research published in 2019 and early 2020 is changing the approach I take to treat Bartonella. Previous research showed Bartonella has rapidly growing germ forms - thus 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. In addition, this new research shows that Bartonella can form 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 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 includes:
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 four to six 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 his colleagues at Johns Hopkins show that rifampin and azithromycin are the strongest agents. These are followed closely by doxycycline, methylene blue, oregano oil, and ciprofloxacin. In his experiments he did not study rifabutin, minocycline, clarithromycin, or levofloxacin. The following combinations of antibiotics are in the same family: rifabutin and rifampin, minocycline and doxycycline, clarithromycin and azithromycin, and levofloxacin and ciprofloxacin. If one member in a family works well the other one is likely too - so clarithromycin, minocycline, and levofloxacin should work well too.
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/methylene blue, rifampin/methylene blue, azithromycin/ciprofloxacin, and rifampin/ciprofloxacin.
In Zhang’s 2020 study, he showed that the best combinations for persister Bartonella also are the strongest at removing biofilms. Thes combinations are: azithromycin/methylene blue, rifampin/methylene blue, azithromycin/ciprofloxacin, and rifampin/ciprofloxacin.
In addition to these combinations, I also find that other biofilm busting herbal medicines like oregano oil, lumbrokinase, the herbs in Biocidin LSF by Biobotanical Research, 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 ten steps in The Ross Lyme Support Protocol. These steps are designed to:
Research suggests Bartonella replicates and creates new germs every 24 hours. This means during any period off of antibiotics, Bartonella grows back. 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 of 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. 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 to 90 percent of the time. Tier Three seems to work 70 to 75 percent of the time or less.
As I noted above, there is no useful clinical 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 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 oregano oil to treat persister forms, remove biofilms, and to treat growing forms. I list the combinations in order of effectiveness. The strongest treatments are at the top. Note, all of these can be effective depending on the person.
Here is how to dose the various prescriptions and the oregano supplement in these combinations:
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 Oregano Oil
I started using the houttuynia and sida acuta together in the summer of 2015. Based on Zhang’s research I now include oregano oil to treat persisters and biofilms. This combination effectively supports a Bartonella treatment about 70 to 75 percent of the time.
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. And I have not had any success using the Beyond Balance herbal products.
For most of the combinations described above, treatment requires four to six months. Treat until most of the Bartonella symptoms go away. Fortunately, 95 percent of people recover from Bartonella using the immune supports and Tier One or Two approaches. 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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