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Babesia treatment in Lyme disease treatment

Kills Babesia: A Brief Guide.

In my experience recovering from babesia, 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.

Boost the Immune System and Decrease Inflammation

It is critical for babesia recovery to take steps that boost the immune system. Do the first 9 steps in The Successful Treatment Recipe to do this. These steps correct sleep, decrease inflammation cytokines, help the immune system adapt to stress, correct hormone imbalances, provide essential micro-nutrients, and remove yeast overgrowth in the intestines if present.

Use Combination Antibiotics

Babesia is a blood parasite like the parasite that causes malaria. To treat it I use 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 immune suppression caused by Lyme. To cure 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. Unfortunately 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.

Tier One

The following approaches work about 85% of the time based on my experience. Dosing is for adults. All of the tier one approaches are prescription medicines.

Atovaquone/Proquanil Combinations

Atovaquone/proquanil 250mg/100mg (Malarone is the brand name). Start the atovaquone/proquanil 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) 500mg 1 time a day,
  • clarithromycin (Biaxin) 500mg 1 pill 2 times a day,
  • doxycycline 100mg 2 pills 2 times a day, or
  • minocycline 100mg 1 pill 2 times a day.

In addition if these combinations are not working I sometimes add

  • sulfamethoxazole/trimethoprim 800mg/160mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone) is two drugs in one pill).

Atovaquone Combinations

Atovaqone (Mepron) 750mg/5ml combined with one of the following 5ml two times a day. In 1 to 2 months if night sweats or other babesia symptoms are not improving then increase the dose to 10ml two times a day. Combine it with one of the following:

  • azithromycin (Zithromax) 500mg 1 time a day,
  • clarithromycin (Biaxin) 500mg 1 pill 2 times a day,
  • doxycycline 100mg 2 pills 2 times a day, or
  • minocycline 100mg 1 pill 2 times a day.

In addition if these combinations are not working I sometimes add

  • sulfamethoxazole/trimethoprim 800mg/160mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone is two drugs in one pill).

Be sure to take atovaqone with fat. 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 flax see oil, yogurt, cheeses, and avacado.

Tier Two

The following regimens work 75% to 80% of the time based on my experience. Dosing is for adults.

Artemesinin

Artemesinin 100mg 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 artemesinin this way because the intestines develop an enzyme that destroys this herbal medicine if it is used longer than 3 days. Be aware the dose on the 3 days is quite strong. Often it causes a worsening of the babesia symptoms beginning on the 2nd day and sometimes lasting until 6 days later. If a person is very medicine sensitive I start at 1 or 2 pills 3 times a day.

I sometimes combine Artemesinin with atovaquone, atovaquone/proquanil, or mefloquine if the it is not working well enough.

Over the past two years some of my colleagues in the east coast of the United States report artemesinin is not working well. However I still find it effective for those that acquire babesia in other parts of the world.

Mefloquine Combinations

Mefloquine 250mg (Lariam) 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 disolves and is stored in fat. It takes 5 days or longer to saturate or to fill up the fat. Once the fat is saturated, the medicine only needs to be taken every 5 days.

Combine it with one of the following:

  • azithromycin (Zithromax) 500mg 1 time a day,
  • clarithromycin (Biaxin) 500mg 1 pill 2 times a day,
  • doxycycline 100mg 2 pills 2 times a day, or
  • minocycline 100mg 1 pill 2 times a day.

In addition if these combinations are not working I sometimes add

  • sulfamethoxazole/trimethoprim 800mg/160mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a 4 drug regimen. (Atovaquone/proquanil (Malarone is 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 works about 75% of the time. Take it as 5ml 3 times a day. My preferred source for this is Woodland Essence. In addition to using Cryptolepis to treat active babesia I sometimes will use it as a preventive medication in a person who has a babesia relapse. See the relapse section below.

Artemether/lumefantrine

Artemether/lumefantrin 20mg/120mg (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 2nd and 3rd 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 2, 3 or 4 weeks. I usually start every 2 weeks and increase the time between each cycle as long as symptoms do not return on the off medicine days.

Tier Three

I call these the “if all else fails” approaches. I use these approaches for various reasons. Generally each is effective about 75% to 85% of the time. The Nitazoxanide is in this group because if it is quite expensive and often insurance will not pay for it. Without insurance it costs around $1400 a month. And Clindamycin/Plaquenil/Quinine work but have many side effects that make them hard to take.

Nitazoxanide

Nitazoxanide 500mg (Alinia) is a prescription medication is approved for the treatment of intestinal parasites. However it seems to help with babesia as well. Take 1 pill 2 times a day. In the US it is sold as a brand only medication. In Canada it is made only at compounding pharmacies but does not seem to be as effective as the brand version.

Clindamycin and Hydroxychloroquine

Clindamycin 300mg (Cleocin) and either Hydroxychloroquine 200mg (Plaquenil) or Quinine Sulfate 324 mg is an old time combination that can treat Babesia. However it is very hard to tolerate for most due to side effects. Hydroxychloroquine is a quinine-like medication that is easier to tolerate than the Quinine Sulfate. However 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 300mg 2 pills 3 times a day and Quinine Sulfate 324mg 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 300mg 2 pills 3 times a day and Plaquenil 200mg 1 pill 2 times a day.

Relapse Prevention

In my experience 95% of people with babesia in Lyme can be cured of it. However a number of people do relapse or may not ever be able to be off medications. If a person recovers from babesia but then relapses after the germ is under control with one of the above regimens, then I will leave the patient on a preventive regimen.

  • Option 1. Atovaquone/Proquanil 250mg/100mg (Malarone) 1 pill daily.
  • Option 2. Cryptolepis Plus combination 4ml 2 times a day for 2 or 3 weeks on each 4 weeks. Or use Cryptolepis 5ml 3 times a day for 2 or 3 weeks on each 4 weeks. Find the frequency that works best.
  • Option 3. Artemesinin 100mg 2 or 3 pills 3 times a day for 3 days in a row of each 14 days. Repeat this cycle continuously.

by Marty Ross MD

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2 comments

  1. Dr Ross, how long do you find one need to treats for babesia before they see improvement and how long should they continue treating?