When a disease is diagnosed soon after a tick bite, this is considered to be the acute stage. This chapter reviews treatment strategies for acute tick-borne disease. We’ll build on the signs and symptoms discussed in chapter 2 and look at specific protocols used to treat each disease. These protocols often include pharmaceutical antibiotics as well as herbal antimicrobials. The good news is, prompt comprehensive treatment of acute tick-borne disease usually results in full recovery.
If you develop symptoms after a tick bite, I call this a symptomatic tick bite. The treatment of a symptomatic tick bite is different from the treatment of an asymptomatic bite — that is, one that does not produce symptoms of disease. With symptoms surfacing, there is a possible active infection. Therefore, report symptoms to a medical professional, preferably someone who is Lyme and TBD literate. If such a provider is not available, visit your health-care provider, the emergency room, or an urgent care center.
If you think you have found a bull’s-eye rash on your body or rash around a tick bite that is increasing in size, take a picture of the rash. Then take a pen or marker, draw a line around the edge of the rash, measure the rash’s diameter, and jot that measurement down. As its name migrans suggests, an erythema migrans, or the Lyme rash, will migrate or spread outward from the bite site on the body. It will over time grow to a diameter of at least 5 centimeters. Give your health-care provider a description of this kind of a rash along with any other symptoms you may be experiencing. Ultimately, an erythema migrans is diagnostic for Lyme disease. Therefore, the treatment of an erythema migrans rash is a treatment for active, current Lyme disease (see next section). A blood test is not needed to confirm Lyme disease in the case of a diagnosed erythema migrans. In the absence of an erythema migrans, but with the development of other new symptoms, diagnosis is more complicated and blood tests may be appropriate.
If you have not already started a tick bite formula appropriate for the tick that bit you (refer to chapter 4), I recommend starting the formula immediately after noticing symptoms. See chapter 4 for dosages. The tick bite formulas should be taken on an empty stomach — that is, 30 minutes before food and 2 hours after food. Also, I recommend using the biofilm buster serrapeptase at 500 mg or 120,000 units twice daily on an empty stomach.
Depending on the constellation of symptoms after a tick bite, I might recommend a specific treatment that includes pharmaceutical antimicrobials in addition to using a tick bite formula and serrapeptase. No matter what protocol you follow, I recommend continuing treatment for 2 months past the resolution of symptoms in order to eradicate the disease.
If you are diagnosed with acute Lyme or other tick-borne disease, that means you have a current active infection that must be treated. I recommend finding a Lyme-literate practitioner to work with. Once symptoms appear or a disease has been diagnosed, shift gears from prevention to active treatment of disease. Pharmaceutical antimicrobials are most effective when used immediately upon diagnosis. In addition, the appropriate herbal antimicrobials and serrapeptase may be used with any of the protocols. The more tools used in the beginning of treatment, the less likely there will be an ongoing infection, especially with Lyme disease.
In this section, we’ll examine acute tick-borne disease treatment plans that use both pharmaceutical and herbal antimicrobials. Since no two cases of Lyme or any other tick-borne disease are alike, treatment should be individualized to each person. Although there are basic principles to follow when treating TBD, I find it crucial to customize the treatment. Many factors like age, drug allergies, alcohol use, sun exposure, side effects, history of antibiotic use, and history of gastrointestinal disease/distress are considered in creating the optimal plan. And it bears reiterating: it is important to continue treatment for 2 months past the point when symptoms resolve.
All of the treatments in this chapter are designed for an average 150-pound nonpregnant adult. See information on adjusting the dosages for children. See information on treating tick-borne disease in pregnancy.
In the event of an erythema migrans, diagnosed Lyme disease, or the development of symptoms after a tick bite that indicate Lyme disease, a specific treatment approach is indicated, one that treats all the ways Lyme bacteria exist and hide in the body. The spirochete form of the Borrelia can be treated by certain pharmaceutical and herbal antibiotics. The most common antibiotic used to treat Lyme disease is doxycycline. Other pharmaceutical antibiotics that can kill the spirochete form are cefuroxime, amoxicillin, azithromycin, clarithromycin, and trimethoprim-sulfamethoxazole. To eradicate the infection, however, it’s important to add additional treatment. The round body form of the bacterium can be treated by only a select few pharmaceutical antibiotics like metronidazole, tinidazole, and hydroxychloroquine. Adding the following herbal antibiotics to address the round body form is recommended: cat’s claw, Japanese knotweed, and andrographis. Grapefruit seed extract also kills the round body form. All of the herbal antibiotics used to treat Lyme disease have the ability to kill both the spirochete form and the round body form.
In addition, the issue of biofilm must be tackled. As we discussed in chapter 2, biofilm is a shell that pathogens create around themselves to survive. Pharmaceutical antibiotics are not effective against biofilm. A treatment protocol must utilize a natural biofilm buster like serrapeptase, nattokinase, lumbrokinase, bromelain, oregano oil, N-acetyl-cysteine, or stevia to break through biofilm. Then the bacteria that are hiding inside biofilm will be exposed to the pharmaceutical and/or herbal antibiotics. Addressing the ways in which Borrelia hides will create a more effective treatment. I emphasize, again, the importance of treating the infection for 2 months after symptoms have resolved. Stopping treatment too soon is a common mistake and often leads to the return of symptoms.
Here is a typical acute Lyme disease treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
If doxycycline cannot be used, or if photosensitivity is of great concern (as may be the case in summer), cefuroxime (500 mg twice daily) or azithromycin (500 mg once daily) are appropriate alternatives.
The second Lyme/borreliosis formula in this protocol is optional but helpful. It contains a combination of herbs that preserves the body’s natural immune response to Borrelia and prevents the bacteria from steering the immune response in favor of their survival. It also offers significant neurological and joint support, bolstering two systems commonly affected by Borrelia.
Fortunately, anaplasmosis responds very well to treatment and does not tend to cause an ongoing infection. Doxycycline is the only antibiotic that treats Anaplasma, and it does so very well. The American Academy of Pediatrics Committee on Infectious Diseases recommends doxycycline in children of all ages as the first-line treatment of anaplasmosis.
Here is a typical acute anaplasmosis treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
Here is a typical acute babesiosis treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
Fortunately, ehrlichiosis responds very well to treatment and does not tend to cause an ongoing infection. Doxycycline is the only antibiotic that treats Ehrlichia, and it does so very well. The American Academy of Pediatrics Committee on Infectious Diseases recommends doxycycline for children of all ages as the first-line treatment of ehrlichiosis.
Here is a typical acute ehrlichiosis treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
It is of utmost importance to immediately treat rickettsial spotted fever group. Rocky Mountain spotted fever can be life threatening and requires treatment with a tetracycline antibiotic, like doxycycline. The CDC and the American Academy of Pediatrics Committee on Infectious Diseases recommend doxycycline for children of all ages as the first-line treatment of rickettsial spotted fever group. The duration of treatment is at least 10 days.
Here is a typical acute rickettsial spotted fever group treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
The treatment of acute tularemia depends upon the severity of the infection. I have not treated acute tularemia in my practice, but I have included standard medical treatment guidelines (the pharmaceutical antibiotics listed) in addition to my herbal recommendations.
Here is an example of an acute tularemia treatment protocol for a nonpregnant adult (and children with the adjustment of dosage based on weight):
For Severe Illness
For Moderate to Mild Illness
There is no pharmaceutical antiviral treatment for Powassan virus. Most patients are hospitalized and receive intravenous fluids, respiratory support, and medication to decrease brain swelling. I have not treated acute Powassan virus, but I recommend the following protocol, based on Stephen Buhner’s book Herbal Antivirals, in addition to conventional medical care.
There is no pharmaceutical antiviral treatment for Heartland virus. I have not treated acute Heartland virus, but I recommend the following, based on Stephen Buhner’s book Herbal Antivirals.
Here is typical acute TBRF treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
If tetracycline cannot be used, use doxycycline (200 mg every 12 hours) or erythromycin (500 mg every 6 hours). Cefuroxime (500 mg twice daily) may be used in the treatment of Borellia miyamotoi or B. turicatae.
There is no pharmaceutical antiviral treatment for Colorado tick fever virus. I have not treated acute Colorado tick fever, but I recommend the following, based on Stephen Buhner’s book Herbal Antivirals.
Southern tick-associated rash illness (STARI) is most likely caused by a Borrelia species. Therefore, the treatment is the same as for Lyme disease.
Here is a typical acute STARI treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
If doxycycline cannot be used, or if photosensitivity is of great concern (as may be the case in summer), cefuroxime (500 mg twice daily) or azithromycin (500 mg once daily) are appropriate alternatives.
While it has not been proven whether Bartonella is transmitted by ticks to humans, I do see persistent bartonellosis in my practice. I suspect that Bartonella was transmitted by contact with fleas in many cases.
Here is a typical acute bartonellosis treatment protocol that I recommend for a nonpregnant adult (and children with the adjustment of dosage based on weight):
The following pharmaceutical antimicrobials are included in the acute tick-borne disease protocols discussed in this chapter.
Doxycycline is from the tetracycline family, a bacteriostatic antibiotic that crosses the blood-brain barrier. Bacteriostatic means that the agent stops the bacteria from reproducing. Doxycycline inhibits bacterial protein synthesis by binding to the 30S subunit of the ribosome — the smaller subunit of a bacterium’s ribosome — and thereby slowing cell growth. It should be avoided in pregnancy and while breastfeeding except when no other antibiotic options exist. Side effects include severe sun sensitivity and gastrointestinal discomfort. Foods that are rich in magnesium, calcium, or iron, such as dairy and almond products, as well as antacids, should be avoided within 2 hours before or after you’ve taken doxycycline, as they will decrease its efficacy.
Cefuroxime is from the cephalosporin family, a bactericidal antibiotic that crosses the blood-brain barrier. Bactericidal means that the agent kills the bacteria. Cefuroxime inhibits cell wall growth, thereby killing the cell. It is safe to use in pregnancy, while breastfeeding, and in children.
Azithromycin is from the macrolide family, a bacteriostatic antibiotic that has a limited ability to cross the blood-brain barrier. Azithromycin inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome and thereby slowing cell growth. It is used with atovaquone to treat babesiosis, which is caused by a protozoan, not a bacterium. It is safe to use in pregnancy, while breastfeeding, and in children.
Atovaquone is an antimalarial drug from the class of naphthoquinones. Atovaquone inhibits the mitochondrial electron transport chain, thereby slowing growth. It must be taken with a high amount of fat to be best absorbed. Do not take with CoQ10, which will interfere with the efficacy of atovaquone.
Streptomycin and gentamicin, from the aminoglycoside family, are bactericidal antibiotics that have limited ability to cross the blood-brain barrier. They create fissures in the outer membrane of the bacterium and inhibit bacterial protein synthesis by binding to a part of the 30S subunit of the ribosome.
Ciprofloxacin is from the fluoroquinolone family, a bactericidal antibiotic that crosses the blood-brain barrier. Ciprofloxacin prevents replication of bacterial DNA. One side effect to note is the potential for tendonitis or tendon rupture.
Rifampin, from the rifamycin family, is a bactericidal antibiotic that crosses the blood-brain barrier. Rifampin inhibits bacterial RNA synthesis. A side effect includes orange-red discoloration of bodily fluids like urine and tears.
Common side effects of pharmaceutical antimicrobials include nausea, vomiting, loose stool, and abdominal pain. Specific antimicrobials may have other side effects.
Pharmaceutical antibiotics are indiscriminate in killing bacteria; they destroy not only disease-causing bacteria but also the beneficial bacteria that help our bodies maintain gut health. For this reason, it is recommended to take probiotics — a replenishment of beneficial bacteria — while on an antibiotic regimen. Probiotics should be taken at least 2 hours before or after an antibiotic dose. They can prevent the gastrointestinal side effects of pharmaceutical antibiotics as well as prevent and treat C. diff (Clostridioides difficile), a secondary bacterial infection that can accompany the use of some antibiotics and causes watery diarrhea. Taking probiotics that contain the “good yeast” Saccharomyces boulardii has been shown to prevent C. diff.57In addition to probiotics, I usually prescribe nystatin, a pharmaceutical antifungal agent, when antibiotics are used for longer than 1 month in order to prevent vaginal or oral candidiasis (yeast overgrowth). When taking antibiotics for over 1 month, you may add two 500,000-unit tablets of nystatin twice daily with the antibiotic prescribed.
This is not a complete list of the antimicrobials used to treat Lyme and other tick-borne diseases. Please discuss side effects, drug interactions, and contraindications with your prescriber.
Diet is also very important. I recommend avoiding foods that feed Lyme and tick-borne disease: sugar, yeast, and alcohol. You might also consider an anti-inflammatory diet. Be sure to drink at least 2 to 3 liters of water daily during treatment.
There are two medically recognized standards of care in the medical community for the diagnosis and treatment of Lyme disease and tick-borne disease. Conventional medical practitioners most often follow the CDC or the Infectious Diseases Society of America (IDSA) guidelines. However, guidelines are also available from the International Lyme and Associated Diseases Society (ILADS), which, as this nonprofit medical society describes itself, is focused on advancing the standard of care for Lyme and other tick-borne diseases through research, education, and policy. ILADS guidelines recommend longer and more comprehensive treatment and recognize a wider variety of effective diagnostic tests and treatment methods. The ILADS guidelines, in fact, are currently the only guidelines in compliance with the Institute of Medicine’s standard for rigorous evidence assessment tool called GRADE.58
As a practitioner, I follow the ILADS guidelines in addition to relying on my own clinical experience. Since I have sought out additional education in the diagnosis and treatment of Lyme and tick-borne disease, I am considered to be a Lyme-literate naturopathic doctor (LLND). There are other Lyme-literate health-care professionals, like Lyme-literate medical doctors (LLMD), nurse practitioners, physician’s assistants, acupuncturists, Chinese medicine doctors, and psychologists. Often, like myself, Lyme-literate health professionals are ILADS members, have trained with an ILADS medical practitioner, and attend conferences for continuing education.
Within the Lyme-literate community . . . there has been a bridging of conventional medicine and natural therapies. Past the initial phase of Lyme disease, a holistic approach has been realized to hold incredible value and importance.
Lyme-literate practitioners, by definition, support the idea that Lyme can continue to cause illness in the body past the initial acute phase of diagnosis and treatment. Lyme-literate medical professionals will take a complete history of your illness, will review lab results that you have had, and might recommend more accurate testing for Lyme and other tick-borne diseases. They might recommend a longer-term treatment protocol.
Years ago, long-term antibiotics were the main treatment strategy for Lyme and other tick-borne diseases. More recently, as research and decades of clinical practice have provided us with a better understanding of the disease process and treatment, conventionally trained medical providers have embraced, researched, and utilized many strategies beyond pharmaceutical antibiotics. And so, within the Lyme-literate community, and specifically the ILADS community, there has been a bridging of conventional medicine and natural therapies. Past the initial phase of Lyme disease, a holistic approach has been realized to hold incredible value and importance.
A Lyme-literate naturopathic doctor (LLND) has learned more about the diagnosis and treatment of Lyme and tick-borne disease based on scientific evidence beyond the scope of conventional medical guidelines while employing naturopathic philosophy, diagnostic testing, and treatments. Naturopathic physicians emphasize finding the cause and treating the whole person. This treatment philosophy is inherently well suited for patients with chronic disease in general, and Lyme and TBD in particular. Lyme literacy calls upon integrative, complementary, or holistic medicine to fully address the needs and concerns of this special population of patients. It requires a special lens to truly see what is going on for these patients and address the causes of their disease.
You can find a Lyme-literate practitioner through any of the following organizations:
See the Resources for contact information for these organizations.