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"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
In my experience, recovering from bartonella, one of the Lyme disease co-infections, requires
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.
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
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.
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:
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.
I combine Bactrim DS 1 pill 2 times a day with either a macrolide or a tetracycline.
Use one of the following macrolides:
Or use one of these tetracyclines:
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:
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.
Use one of the following macrolides:
Combine these with a tetracycline:
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.
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.
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