Kills Bartonella: A Brief Guide

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How to kill bartonella in a Lyme disease treatment image from 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.

Limited research shows which antimicrobials work best for Bartonella. Existing studies are petri dish experiments showing intracellular antibiotics (ones that get inside of cells) work best. Hence, the antibiotic treatments I describe below use these intracellular antibiotics.

Unfortunately, no studies about Bartonella treatment exist in people living with Lyme. As a result, most experienced Lyme Literate Medical Doctors use their clinical judgment to determine that it can take four to six months of continuous antimicrobials for Bartonella to resolve.

In my 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—it is possible to cure Bartonella 95 percent of the time, in my experience. This means five percent of people may have relapses or require treatments involving a number of the different approaches below.

Marty Ross MD Discusses Bartonella Treatment

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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 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 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. 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. Tier Three is for the person who cannot tolerate prescription antibiotics or when the prescriptions do not work. Tier One combinations appear to work 90 percent of the time and Tier Two about 80 percent of the time. Tier Three seems to work 70 percent 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 one to two 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. 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.

Bactrim-based Treatments

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). Combine levofloxacin 500 mg 1 pill 1 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.

Use Fluoroquinolone-based treatments as a last resort, 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 effectively supports a bartonella treatment about 70 percent 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, 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.

Treatment Course

For most of the combinations described above, treatment requires four to six months. The only exception to this is a treatment that includes levofloxacin, which typically requires one to three months. Treat until most of the Bartonella symptoms go away. Fortunately, 95 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 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.


View Citations

  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. doi:10.2217/fmb.10.133.

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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 is currently on sabbatical in Austin, TX. Dr. Ross plans to reopen his Seattle Lyme practice in early 2020.

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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