Posted 5/13/2016 7:27 PM (GMT -5)
Folks I posted this over 3 months ago but I've seen some newer members and interest in Bartonella so wanted to re-post so everyone can get more educated. Note this info is from various medical studies and doctors so don't think anything is sure fire (e.g. 3 months to resolve bartonella on Levaquin). Others chime in if you want to provide clarification. Hope it helps!
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Doing some research ran across someone that posted this with a lot of excerpts on Bartonella treatment. The link is below but took the highlighted parts and pasted here. Hope this is helpful to anyone.
www.lymeneteurope.org/forum/viewtopic.php?t=5305
Thus, with our current knowledge, addition of another antibiotic with good in vivo activity against Bartonella is crucial, because the two antibiotics may eradicate the bacteria in different niches in the host........
Because there are only two reports of randomized clinical trials for the treatment of Bartonella infections, an unequivocal treatment for all Bartonella infections does not exist, and thus, antibiotic treatment recommendations differ for each clinical situation. Treatment of Bartonella infections should be adapted to each clinical situation, to the infecting Bartonella species, and to whether the disease is in the acute or the chronic form.
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Cost-effective pharmaceutical choices include erythromycin or doxycycline. Azithromycin has been shown to be more effective than placebo in resolving lymphadenopathy; some consider azithromycin to be the drug of choice.
No definitive therapeutic study of CNS bartonellosis or neuroretinitis has been performed, but treating these patients seems prudent. Agents that penetrate the CNS or eye are favored, including doxycycline or azithromycin possibly with rifampin, clarithromycin, or a newer fluoroquinolone antibiotic. A combination of 2 drugs is favored because this may speed healing and because no single agent has been found to cure all cases in which it was used
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The therapeutic approach to Bartonella infection varies on the basis of the clinical manifestations and immune status of the patient. There is a paucity of data in the literature as to the most effective therapy in all cases of Bartonella infection, with most data presented as part of case series rather than randomized, controlled trials. There is a significant divide in the literature between in vitro efficacy of antibiotics and the ability to successfully treat in clinical practice
There have been no randomized, controlled trials of antibiotics in Bartonella encephalopathy, and their efficacy is controversial; thus, conservative, symptomatic treatment is usually recommended. If antibiotics were to be used, the combination of doxycycline and rifampin is suggested because of their strong penetration into the central nervous system
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An unequivocal treatment for all Bartonella infections does not currently exist, meaning that antibiotic treatments will vary. Treatment of Bartonella infections should be based on each clinical situation, the infecting Bartonella species, and whether the disease is in the acute or the chronic form. Duration of monotherapy antibiotics can last as little as 2 weeks for some acute illnesses, but can skyrocket to 4 or more months when dual therapy is required for individuals with chronic illnesses. Unfortunately, clinical and microbiological relapse and failures are still being documented.
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CSD is most often treated with tetracyclines, macrolides or aminoglycosides. For CNS infection, antibiotics that cross the blood brain barrier are necessary, and combination therapy is usually recommended, as it may have more efficacy. Among the recommended regimens are azithromycin or doxycycline in combination with rifampin, clarithromycin or a fluoroquinolone. The optimal length of therapy has yet to be determined, but most guidelines suggest that treatment should last for at least 4-6 weeks.
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The use of antibiotics to shorten the course of disease is debated. Most cases of cat scratch disease (CSD) resolve without treatment, although some patients may develop disseminated disease. Azithromycin has been shown to decrease lymph node volume more rapidly compared to no treatment.
A number of other antibiotics are effective against Bartonella infections, including penicillins, tetracyclines, cephalosporins, aminoglycosides, and fluoroquinolones. Since aminoglycosides are bactericidal, they are typically used as first-line treatment for Bartonella infections other than CSD. Often, with serious infections, more than one antibiotic is used.
Trench fever, Carrión's disease, and endocarditis due to Bartonella spp. are serious infections that require antibiotic treatment. Health care providers should consult with an expert in infectious diseases regarding treatment options.
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It has been nearly two decades since the discovery of Bartonella as an agent of bacillary angiomatosis in AIDS patients and persistent bacteremia and ‘nonculturable’ endocarditis in homeless people. Since that time, the number of Bartonella species identified has increased from one to 24, and 10 of these bacteria are associated with human disease. Although Bartonella is the only genus that infects human erythrocytes and triggers pathological angiogenesis in the vascular bed, the group remains understudied compared with most other bacterial pathogens.
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The drug of choice to treat BLO is levofloxacin. There is, however, one side effect
that would require it to be stopped- it may cause a painful tendonitis, usually of the largest tendons. If this
happens, then the levofloxacin must be stopped or tendon rupture may occur
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Such is the case with an important class of antibiotics known as fluoroquinolones. The best known are Cipro (ciprofloxacin), Levaquin (levofloxacin) and Avelox (moxifloxacin). In 2010, Levaquin was the best-selling antibiotic in the United States. But by last year it was also the subject of more than 2,000 lawsuits from patients who had suffered severe reactions after taking it. Part of the problem is that fluoroquinolones are often inappropriately prescribed. In an interview, Mahyar Etminan, a pharmacological epidemiologist at the University of British Columbia, said the drugs were overused “by lazy doctors who are trying to kill a fly with an automatic weapon.”
Adverse reactions to fluoroquinolones may occur almost anywhere in the body.
Fluoroquinolones carry a “black box” warning mandated by the Food and Drug Administration that tells doctors of the link to tendinitis and tendon rupture and, more recently, about the drugs’ ability to block neuromuscular activity. But consumers don’t see these highlighted alerts, and patients are rarely informed of the risks by prescribing doctors. Mr. Balch said he was never told about the black-box warnings.
Lack of Long-Term Studies
No one knows how often serious adverse reactions occur. The F.D.A.’s reporting system for adverse effects is believed to capture only about 10 percent of them. Complicating the problem is that, unlike retinal detachments that were linked only to current or very recent use of a fluoroquinolone, the drugs’ adverse effects on other systems can show up weeks or months after the treatment ends; in such cases, patients’ symptoms may never be associated with prior fluoroquinolone therapy.
No long-term studies have been done among former users of these antibiotics. Fibromyalgia-like symptoms have been associated with fluoroquinolones, and some experts suggest that some cases of fibromyalgia may result from treatment with a fluoroquinolone.
A half-dozen fluoroquinolones have been taken off the market because of unjustifiable risks of adverse effects. Those that remain are undeniably important drugs, when used appropriately. But doctors at the Centers for Disease Control and Prevention have expressed concern that too often fluoroquinolones are prescribed unnecessarily as a “one size fits all” remedy without considering their suitability for different patients.
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The bacterial genus Bartonella comprises 21 pathogens causing characteristic intraerythrocytic infections.
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According to previous and current observation azithromycin would be an appropriate treatment alternative in adult patients, but randomized trials with significant number of patients are necessary in all countries to standardized the therapeutic recommendations [25].
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The Infectious Diseases Society of America guidelines regarding CSD are equivocal about the routine use of antibiotics,23 whereas another panel of authorities recommended against the use of antibiotics in patients with mild or uncomplicated disease.21 Other antibiotics that have been used in CSD include rifampin, ciprofloxacin (Cipro), trimethoprim/sulfamethoxazole (Bactrim, Septra), and gentamicin.
Treatment of bacillary angiomatosis and peliosis, which have high rates of relapse, with oral erythromycin or doxycycline for a prolonged course of three to four months has benefited patients. Treatment with cell wall–active antibiotics has not. Treatment of neurologic disease has not been evaluated, but a combination of erythromycin or doxycycline plus rifampin for four to six weeks may be effective as suggested by case reports of neuroretinitis
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Conclusions Etest is a sensitive and reliable assay for evaluation of antibiotic susceptibility in the genus Bartonella. The higher sensitivity of this method allowed us to detect heterogeneity of susceptibility among fluoroquinolones that was associated with natural mutation in the QRDR of the DNA gyrase. Because a high level of resistance to fluoroquinolones due to a second mutation may be obtained easily in vitro, we believe that fluoroquinolone compounds should be avoided for the treatment of any Bartonella-related diseases.
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Adequate studies are missing for the treatment of bartonellosis. There is no single treatment approved by the US Food and Drug Administration (FDA), the Center for Disease Control (CDC) or the Infectious Diseases Society of America (IDSA) [23]. This applies particularly for the chronic courses of the disease [80]. The use of the following antibiotics are recommended (Table 55): azithormycin [81,82], rifampicin, ciprofloxacin, trimethoprim combined with sulfamethoxazole, gentamycin [83,84], gentamycin i.v. [85], and doxycycline combined with gentamycin [86, 87]. This treatment is based, in part, on expert recommendations
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Use Combination Antibiotics
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. Tier Three I use only as a last resort 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 50% of the time or less.
Tier One:
Rifampin-based Treatments. In these treatments Rifampin is the main effective ingredient. I combine Rifampin 300mg 2 pills 1 time a day with one of the following: minocycline 100mg 1 pill 2 times a day, bactrim DS 1 pill 2 times a day or azithromycin (Zithromax) 500mg 1 pill time a day. Doxycycline 100mg 1 or 2 2 times a day can be substituted for the minocycline, but rifampin decreases doxycycline levels in the blood. Clarithromycin (Biaxin) 500mg 1 pill 2 times a day can be substituted for azithromycin but rifampin also decreases clarithromycin blood levels.
Flouroquinolone-based Treatments. Flouroquinolones are a class of antibiotics that include a number of members like levofloxacin (Levaquin) and ciprofloxacin (Cipro). I combine levofloxacin 500mg 1 time a day or ciprofloxacin 500mg 1 pill 2 times a day with one of the following: minocycline 100mg 1 pill 2 times a day, doxycyline 100mg 1 to 2 pills 2 times a day, or bactrim ds 1 pill 2 times a day. Clarithromycin and azithromycin are not used with flouroquinolones because together they may cause heart rhythm problems. Levofloxacin seems stronger than the ciprofloxacin.
Clarithromycin and Bactrim DS. I combine clarithromycin 500mg 1 pill 2 times a day with bactrim ds 1 pill 2 times a day with good benefit.
Tier Two:
A Macrolide Plus a Tetracycline. Use one of the following macrolides: clarithromycin 500mg 1 pill two times a day or azithromycin 500mg 1 pill 2 times a day. Combine these with a tetracycline: doxycycline 100mg 1 or 2 pills 2 times a day, minocycline 100mg 1 pill 2 times a day, or tetracycline 500mg 1 pill 3 times a day (note tetracycline is not available in the USA).
Tier Three:
A-Bart by Byron White Formulas. These formulas are only available through qualified practitioners. Follow the directions of your physician.
Treatment Course
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 appear resolved. 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.