Babesia Treatment in Lyme Disease
In my experience, recovering from Babesia, one of the Lyme disease co-infections, requires
- combination herbal or prescription antibiotics and antimalarials,
- steps to boost the immune system, and
- supplements to decrease inflammation caused by chemicals called cytokines.
Limited research shows prescription antimalarials work for Babesia. Research supports the combination of atovaquone and azithromycin. There is also research support for the clindamycin and quinine combination. These studies support a seven- to ten-day course of treatment. This is one reason why many insurers refuse to pay for Babesia treatments longer than ten days.
However, there are no studies about Babesia treatment in Lyme. In Lyme, the experience of most experienced Lyme Literate Medical Doctors is that it can take four to five months of continuous antimicrobials for Babesia to resolve.
In clinical practice, many different combinations of herbal and prescription antimalarials work to cure Babesia. 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 Babesia 95 percent of the time, in my experience. This means five percent of people may relapse or require treatments involving a number of the different approaches below.
Marty Ross MD Discusses How to Treat Babesia
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Boost the Immune System to Cure Babesia
It is critical for Babesia 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 Antimalarials to Cure Babesia
Babesia is a blood parasite like the parasite that causes malaria. Therefore, treating Babesia requires using combinations of antimicrobials that are also used to treat malaria. Generally, treatments require four to five months. This length of time is required due to immunosuppression caused by Lyme. Curing Babesia requires treating at least one month longer than the average length of time a red blood cell lives after it is made by the bone marrow in the center of bones. A red blood cell lives for around three months.
As I noted above, there is no useful science to guide treatment decisions for Babesia in someone who has Lyme. What follows is based on my experience treating Babesia in Lyme disease.
In general, if a treatment is working, the symptoms of Babesia 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 Babesia symptoms in How to Diagnose Babesia.
Tier One Babesia Treatments in Lyme Disease
The following approaches work about 85 percent of the time based on my experience. Dosing is for adults. All of the tier one approaches are prescription medicines.
Atovaquone/Proguanil Combinations
Atovaquone/proguanil (Malarone) 250 mg/100 mg. Start the atovaquone/proguanil at 2 pills 2 times a day for 3 days, and then decrease to 1 pill 2 times a day. Combine it with one of the following:
- Azithromycin (Zithromax) 500 mg 1 time a day,
- Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
- Doxycycline 100 mg 2 pills 2 times a day, or
- Minocycline 100 mg 1 pill 2 times a day.
In addition, if these combinations are not working, add
- Sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a four-drug regimen. (Atovaquone/proguanil (Malarone) has two drugs in one pill).
Atovaquone Combinations
Atovaquone (Mepron) 750 mg/5 ml, take 5 ml two times a day. In one to two months, if night sweats or other Babesia symptoms are not improving, then increase the dose to 10 ml two times a day. Combine it with one of the following:
- Azithromycin (Zithromax) 500 mg 1 time a day,
- Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
- Doxycycline 100 mg 2 pills 2 times a day, or
- Minocycline 100 mg 1 pill 2 times a day.
In addition, if these combinations are not working, add
- Sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a four-drug regimen. (Atovaquone/proguanil (Malarone has two drugs in one pill).
Be sure to take atovaquone with fat because this increases its absorption. Take enough fat so the medicine does not cause nausea or diarrhea. Sources of fat include nuts, nut butter, butter, oils like coconut oil and flaxseed oil, yogurt, cheeses, and avocado.
Tier Two Babesia Treatments in Lyme Disease
The following regimens work 75 to 80 percent of the time based on my experience. Dosing is for adults.
Artemisinin
(Note: I understand the herbalist Buhner no longer recommends this medication. However, I still find it very useful using the dosing I recommend below. I do agree with Buhner that it does not work if it is used continuously.)
Artemisinin 100 mg is an herbal medication. Start at 2 or 3 pills 2 times a day for 3 days on the medication, then take 11 days off. Continue this 14-day cycle. The goal is to reach 5 pills 3 times a day on the 3 days the medication is taken. I use artemisinin this way to overcome resistance. Be aware, the dose on the 3 days is quite strong. Often it causes a worsening of the Babesia symptoms beginning on the second day and sometimes lasting until six days later. If a person is very medicine sensitive, I start at 1 or 2 pills 3 times a day.
Artemisinin resistance can occur for two reasons. First, the liver learns to clean artemisinin out more quickly after a person is on it for a few days. The other mechanism could be similar to what happens in malaria. In malaria, partial resistance develops in the germ after a few days. In malaria, it is shown that artemisinin works best by pulsing on and off the drug like I recommend above.
It is possible to combine artemisinin with atovaquone, atovaquone/proguanil, or mefloquine if the artemisinin is not working well enough.
Mefloquine Combinations
Mefloquine (Lariam) 250 mg is a prescription medication. Start at 1 pill daily for 5 days, and then take as 1 pill every 5 days. It may cause nausea on the first five days. Mefloquine dissolves and is stored in fat. It takes 5 days or longer to saturate or to fill up the fat. Once the fat is saturated, taking a pill every 5 days keeps the fat saturated.
Combine it with one of the following:
- Azithromycin (Zithromax) 500 mg 1 time a day,
- Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
- Doxycycline 100 mg 2 pills 2 times a day, or
- Minocycline 100 mg 1 pill 2 times a day.
In addition, if these combinations are not working, add
- Sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4-drug regimen. (Atovaquone/proguanil (Malarone) has two drugs in one pill).
This medication is the most affordable option. In the US, mefloquine is about $70 a month. However, it can have significant mental health side effects like depression and hallucinations or even psychosis. I only use it if there are no other affordable options for my patients.
Cryptolepis
Cryptolepis is an herbal medicine originally used in Ghana to treat malaria. It supports Babesia removal about 75 percent of the time. Take it as 5 ml 3 times a day. In addition to using cryptolepis to treat active Babesia, use it as a preventive medication in a person who has a Babesia relapse. See the relapse section below.
Cryptolepis/Sida Acuta/Alchornea (CSA Tincture)
Cryptolepis/Sida Acuta/Alchornea combines three antimalarial herbs that support Babesia removal. Take 5 ml 3 times a day. Use this if the Cryptolepis alone is not working well enough.
Artemether/lumefantrine
Artemether/lumefantrine 20 mg/120 mg (Coartem) is a prescription medication. Take 4 pills 2 times a day for 3 days. On the first day, take the second dose 8 hours after the first dose. On the second and third day, take each dose 12 hours apart. The 1st dose of the day on all three days should be at the same time. Coartem can be repeated every two, three, or four weeks. I suggest starting every 2 weeks and increase the time between each cycle as long as symptoms do not return on the off-medicine days.
Tier Three Babesia Treatment in Lyme Disease
I call this the "if all else fails" approach. Generally, it is effective about 75 to 85 percent of the time. Clindamycin/Plaquenil/Quinine work, but they have many side effects that make them hard to take.
Clindamycin and Hydroxychloroquine
Clindamycin 300 mg (Cleocin) and either hydroxychloroquine 200 mg (Plaquenil) or Quinine Sulfate 324 mg is an old-time combination that can treat Babesia. However, it is very hard to tolerate for most people due to side effects. Hydroxychloroquine is a Quinine-like medication that is easier to tolerate than the Quinine Sulfate, though Quinine Sulfate may be more effective.
Side effects of clindamycin that make it hard to tolerate include: nausea, diarrhea, abdominal pain, and allergic-type reactions. Quinine Sulfate can cause ringing in the ears but can also cause muffled hearing and other severe neurologic conditions. Generally, as a Quinine-like medication, Plaquenil does not seem to cause these problems.
- Option 1. Clindamycin 300 mg 2 pills 3 times a day and Quinine Sulfate 324 mg 2 pills 2 times a day. If muffled hearing or other neurologic symptoms other than ringing in the ears develop, then decrease the Quinine Sulfate to 1 pill 2 times a day.
- Option 2. Clindamycin 300 mg 2 pills 3 times a day and Plaquenil 200 mg 1 pill 2 times a day.
Nitazoxanide (Alinia)
I use to include nitazoxanide (Alinia) in this group. However, overtime in my Seattle practice I found it to rarely work. Therefore I no longer consider it a treatment option. For more information see Alinia: When & Why in Lyme Disease Treatment.
Relapse Prevention
In my experience, it is possible to cure Babesia in Lyme disease 95 percent of the time. However, a number of people do relapse or may not ever be able to stop medications. If a person recovers from Babesia, but then relapses after the germ is under control with one of the above regimens, then try a preventive regimen.
- Option 1. Atovaquone/proguanil 250 mg/100 mg (Malarone) 1 pill daily.
- Option 2. Cryptolepis 5 ml 3 times a day for 2 or 3 weeks on of each 4 weeks. Find the frequency that works best.
- Option 3. Artemisinin 100 mg 2 or 3 pills 3 times a day for 3 days in a row of each 14 days. Repeat this cycle continuously.
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