The best antibiotics to treat Borrelia miyamotoi?

Borrelia miyamotoi may be a disease you have never heard of. But the threat of this tick-borne illness is very real. First described in Japan in 1995, this emerging infectious disease is transmitted by the same blacklegged tick which carries the Lyme disease pathogen. In “Antimicrobial susceptibility of Borrelia miyamotoi,” researchers examine the effectiveness of several antibiotic regimes in the treatment of HTBRF.

In the United States, as many as 15.4% of the blacklegged ticks were found to be infected with B. miyamotoi, compared with up to 4% in Europe and Japan, according to Koetsveld from the Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, the Netherlands. [1]

Meanwhile, “Seroprevalence studies in New England suggest that B. miyamotoi infection may be as common as anaplasmosis and babesiosis,” write the authors of one study. The researchers randomly tested 250 individuals living in Manitoba, Canada and found that 10% were seropositive for B. miyamotoi. [2]

Although B. miyamotoi is characterized by relapsing fever, a case series published in the Annals of Internal Medicine reports that only 2 out of 50 patients infected with B. miyamotoi actually exhibited a relapsing fever. [3]

“Recurrent fever episodes have only been observed in 10% [of the cases] and spirochetemia is calculated to be low in patients infected with B. miyamotoi,” Koetsveld explains in Antimicrobial Agents Chemotherapy. [1]

Fever episodes last for three days and are accompanied by flu-like symptoms such as headache, chills, abdominal discomfort, arthralgia and myalgia.

So, how do we treat this difficult to diagnose condition?

Until now, there have been no treatment guidelines for B. miyamotoi and regimes have been empirically based on the treatment for Lyme disease. “The antimicrobial susceptibility of B. miyamotoi has not yet been elucidated, due to difficulties with cultivation of B. miyamotoi spirochetes in vitro,” according to Koetsveld.

[bctt tweet=”What is the best way to treat Borrelia miyamotoi?” username=”DrDanielCameron”]

“In this study we describe, to our knowledge for the first time, in vitro susceptibility of B. miyamotoi to the most commonly used antibiotics” in the treatment of B. miyamotoi and Lyme borreliosis.

The study authors demonstrated that B. miyamotoi is susceptible to doxycycline, azithromycin, and ceftriaxone but resistant to amoxicillin in vitro. The next step would be to show whether these drugs work in patients.

Note: This article was originally published July 19, 2017. It has been updated with new content. 

  1. Koetsveld J, Draga ROP, Wagemakers A, et al. In vitro susceptibility of the relapsing fever spirochete Borrelia miyamotoi to antimicrobial agents. Antimicrob Agents Chemother. 2017.
  2.  Kadkhoda K, Dumouchel C, Brancato J, Gretchen A, Krause PJ. Human seroprevalence of Borrelia miyamotoi in Manitoba, Canada, in 2011-2014: a cross-sectional study. CMAJ Open. 2017;5(3):E690-E693.
  3. Molloy PJ, Telford Iii SR, Chowdri HR, Lepore TJ, Gugliotta JL, Weeks KE, Hewins ME, Goethert HK, Berardi VP: Borrelia miyamotoi Disease in the Northeastern United States: A Case Series. Ann Intern Med 2015.

33 Replies to "The best antibiotics to treat Borrelia miyamotoi?"

  • Debra
    06/14/2019 (12:57 am)

    Tiffany…I posted my story on 2-18-2019…I feel like im fighting a loosing battle..I rarely have a good day…I stopped going to doctors when acquiring a staph infection after under going a simple endoscopy procedure…I have become intolerant of alot of foods since this all took place.have constant headaches…The nauseasness make it hard for me to eat..So weight gain is almost impossible..I could go on and on..But if you read my prior post that will explain most..You stated that you feel like your finslly starting to get your life back…What have you done? Antibiotics have destroyed my stomach..Any input would be greatly appreciated..Much Thanks Debra

    • Dr. Daniel Cameron
      06/15/2019 (10:42 am)

      It can be difficult to find an antibiotic treatment if the stomach is part of the illness. The stomach issues can be complicated by autonomic nervous system issues. I find a lower dose or change in antibiotics might help. Probiotics help. I also have used Nystatin 500,000 units.

      BTW I find weight gains early in the illness is also common.

      • Valerie
        07/03/2019 (2:59 pm)

        Greetings Dr. Cameron:

        I have been diagnosed with B. Burgdorferi and B. Miyamotoi along with Babesia Microti, Bartonella Henslae and other co-infections. I’m feeling overwhelmed. I’ve been infected for two years. Been on oral antibiotics for one year. Issues not resolving. Is there any hope to be normal again? Is Miyamotoi impossible to eradicate? I fear that my immune system is overwhelmed. I still have the relapsing fevers. Have any of your patients been cured from these? Thank you –

        • Dr. Daniel Cameron
          07/03/2019 (4:18 pm)

          I shared what I have been reading on B. miyamotoi. I am still waiting for more research. I find it difficult to find the best treatment for some of my patients. I also consult other doctors.

        • Fred
          05/04/2020 (12:53 pm)

          You can try Ciprofloxacin. It is very good for babesia and bartonella. I personally think that it is very good for borrelia too. If you have serious infections the two major antibiotics to use are Amoxicillin and Ciprofloxacin.

          • Dr. Daniel Cameron
            05/04/2020 (2:11 pm)

            Ciprofloxacin can lead to tendonitis and tendon rupture in some cases.

  • Tiffany
    06/11/2019 (2:02 am)

    Was bit by something/contracted what looked like poison ivy in May 2017 which erupted up my left arm via an itchy but bubbly patch, & eventually full body mini rashes. By October I was tired, had a cough, constant post nasal drip, had left ear fullness, pulsatlle tinnitus in my left ear as well. By the end of October, I ended up in the ER when I felt like I was drunk driving home, yet had nothing to drink. My ceiling fan was oscillating when it was actually not even turned on! I was nauseous, heart palpation, dizzy, ear fullness on one side. Doctors thought it was vertigo/Meniere’s & sent me on my way after all tests came back negative, including Lyme. This started my quest for answers, which included seeing 52 doctors between RI, MA, CT, NY, & even the Mayo Clinic. I was finally diagnosed with Borrelia miyamotoi in February 2018 & put on a course of Doxy, followed by Rifampin & Omnicef to clear any secondary infections. This wrecked my gut, which led to close call with UTI infection that was close to being antibiotic resistant. I almost had to have a picc-line placed just to take IV antibiotics for it. Fortunately an infectious disease doc in RI (good luck getting in to see them….the office hours are TERRIBLE and we only have literally 2 doctors in the entire state) found a pill form to try. A hematologist in RI actually diagnosed my Borrelia infection. This was AFTER a rheumatologist in Boton told me there was nothing she could do for me, & the hematologist in Boston she sent my files to said he didn’t have anything else to add. And we’re talking big hospitals up there, folks. By June 2019 I finally feel like I have started to get my life back. It has been an awful ride for this 38 year old.

    • Valerie
      07/03/2019 (1:52 pm)

      Tiffany, I live in Boston and I’m 42. I’ve had a terrible time here at the “big” hospitals with getting proper diagnoses. They all sent me away saying my Lyme tests were negative last year. A blood testing lab in Germany, Armin Labs, finally gave me accurate blood tests with all of my tick-borne infections recently. I have Borrelia Myamotoi and Burgdorferi, Babesia Microti, Bartonella Henslae, and several other co-infections. Did any of those meds you were taking actually cure/ eradicate the Myamotoi?? I’m completely overwhelmed and feel like I want to die. Which pill form are you taking??

  • Nancy
    05/08/2019 (10:07 am)

    Has anyone who has posted here tried minocycline. I have found it will diminish the arthritic and neurological disorders of these nasty TBD’s. I am speaking from my own experience and from observing my dog who has RMSF. We also consumed honeycomb which eliminated most of the pain(better than Alleve).

  • Walter Taylor
    04/22/2019 (4:22 pm)

    Former Land Surveyor’s Health Deterioration & Being Marginalized Due to Lyme in California

    Igenex Laboratory near San Jose, CA developed a new immunoblot test in late 2018 for “TBRF”, which is tick-borne relapsing fever. TBRF is a medically recognized chronic category of Borrelli species variants and according to the California Department of Public Health is endemic to California. In 2008, the National Institutes of Health published a clinical symptoms & treatment guidelines on the diagnosis of Tick-Borne Relapsing Fever.

    I have all the symptoms of TBRF: including CNS involvement with cranial nerve palsies-relapsing/remitting episodes of diplopia, exophoria & iradocyclides. I also have relapsing/remitting gate ataxia and intermittent dificulties getting up from a chair.

    Definitive brain MRI’s showing progressive loss of cerebellar volume & increasing T-2 foci throughout my brain, with relapsing remitting thrombocytopenia, polycythemia and ANA titers with a persistent speckled pattern, previous diagnosis & treatment for Spotted Fever Group Ricketsia (SFGR) with currently fluctuating positive IGG antibodies, periodic 3-day fevers, as well as an Igenex positive TBRF IgG Immunoblot for 3 Borrelia-species proteins, GlpQ, Dipa, & P41, cooresponding to specific species variants of Borrelia, including miyamotoi.  

    Intermittent urilogical symptoms of hematuria, proteinuria and hylane casts, cystic fibrosis symptoms, a rash that flares then recedes, systemic inflamation with dramatic fluctuations of creatine kinase and myalgias throughout my body.

    I finally got an appointment at Stanford Health Care (SHC) Infectious Disease Department after 4 years of multiple SHC rheumatological and neuromuscular appointments, currently finding “no definitive rheumatological condition” or “idiopathic neuropathy”.

    The Stanford Infectious Disease “Fellow” wrote a “cut & paste” clinic report, echoing “word for word” a previous “poor historian” 2011 report, that was written by another “fellow” at UCSD and written after I was tested at Mayo DLMP, CDPH-VRDL & CDC-RZB, diagnosed at UCLA and treated  for SFGR. 

    That UCSD “fellow” claimed in her 2011 report that different labs had performed the testing but she completely ignored and never mentioned in her 2011 report that the California Department of Health-Viral & Rickettsial Disease Laboratory (CDPH-VRDL) detected IgG & IgM SFGR antibodies from the Mayo DLMP provided paired sera sample and, because that paired sera sample tested IgG & IgM positive for SFGR, which constituted a  “CDC serologically confirmed case”, the paired sera sample was then sent to the CDC- Rickettsial Disease Branch (CDC-RZB). That UCSD “fellow” described in her 2011 clinic report that the CDC testing were “false positives”.

    Unfortunately, millions of patients suffer because clinical practitioners refuse to stay current with the latest Lyme disease research. One of many clear symptoms of America’s broken healthcare system.

  • Lyme Disease
    04/18/2019 (9:00 am)

    I was bitten by a couple of ticks in Europe. Fever, spotted rash, acne like eruptions on my back, headache, paranoia, light-sound sensitivity and relapsing fevers and swollen lymph nodes. I didn’t leave my bed for three months. Prior I worked 70 hours a week, lifted weights daily and was fit and healthy.

    I didn’t test positive for rickettsia which they suspected due to spotted rash, they found Bartonella through antibody test (due to lymphadenopathy it was tested). Lyme disease was negative.

    However I developed Bell’s Palsy and delayed reflexes which is not a typical neurological sign that Bartonella causes. Zapps of electricity down my spine. Dizzy spells. Forgetfulness and confusion. Headaches. This went on for 2 years until I lost 20 pounds.

    Because of the relapsing fevers they suspected something else. I had incredibly strong herxheimers to antibiotic treatment. Stronger than usually seen with Lyme disease. It also caused paper-thin, wrinkled shiny skin on my hands and feet which looked exactly like ACA.

    Tickborne diseases are much more mysterious and the presentation is much more ellusive than textbooks describe.

    Standard antibiotics doxycycline and azithromycine didn’t do much for neuro- and joint symptoms and the Lyme-like symptoms always returned. Ceftriaxone worked better for the joint- and psycho-neurological symptoms and amoxicilline did nothing.

    Despite A LOT of antibiotics I continue to test positive by PCR and culture positive for Bartonella. That is a though bacteria to treat. The strain I have doesn’t respond to doxycycline, bactrim, rifampin, azithromycin or ciprofloxacin. I hope there are researchers that would like to isolate it for studies from my blood which would be difficult because the microbiologist said it is such a fastidious species and they were lucky to culture it (multiple times) from my blood.

    Doctor said that it might have been miyamotoi but the doctors that work with the specialty lab had no interest in seeing me. So my ID specialist went rogue and treated me according to ILADS guidelines. He even did his best to do pcr’s and cultures of my blood after finding sky-high antibodies for Bartonella and tried treating it. He thinks it is chronic in my case.

    I’m glad you updated the article about miyamotoi and said it is resistant to amoxicilline. Dutch scientists found that some years earlier. Important information!

    • Fred
      10/29/2020 (8:41 pm)

      For treatment of chronic bartonella infection the use of two antibiotics is a must: Doxycycline + Rifampin. The dosage is 400mg/day Doxy which means 2x200mg per day + 600mg/day Rifampin which means 2x300mg per day. The protocol is quite time consuming, 4 to 6 weeks of treatment in order to clear the bartonella infection.

      • Dr. Daniel Cameron
        11/03/2020 (7:45 pm)

        I find I need to individualize treatment. Neither doxycycline nor Rifampin work for Babesia.

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