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?"

  • Linda Highley
    09/14/2022 (5:13 pm)

    has anyone used Rifampin and minocycline to treat Lyme and Ehrlichiosis?
    I read that Rifampin can cause your teeth to turn red! (is that a real side effect?)
    I have never used these before so I am a little apprehensive. Just want to know if this is a good combination?

    • Dr. Daniel Cameron
      09/15/2022 (4:52 pm)

      I have had patients report pink urine with Rifampin but not red teeth

  • Dana
    07/30/2020 (8:10 pm)

    I am very sick with mostly sibo type digestive problems but some joint pain and pot type symptoms and fatigue . I’ve lost 35 lbs and weight 78 lbs now. I have positive Lyme test on western blot and positive dna test for Borrelia, Babesia, Bartonella, Ehrlichia. After a year of these illnesses with no answers until now. My doctors says they have done experience with treating Lyme but doesn’t seem confident in what to treat first or is best. They have decided to treat with Iv rocephin for 3 weeks. Do you think this is what you would start treatment with ? Would else do you think I they might need to add or I’d this enough?

    • Dr. Daniel Cameron
      07/31/2020 (8:03 am)

      It can be confusing as to whether Lyme disease and a tick borne illness are responsible for an illness. I don’t start my patients on IV. They often get better with an oral antibiotic alone.

  • Nancy
    07/08/2019 (7:38 pm)

    My son has Down syndrome 28 years old. Imugen labs results b miyamotoi IGM negative. B miyamotoi IGG positive. igenex testing shows lyme western blot **41. And borreliosis 41 intermediate. He is on amoxicillian 875 2x day. Was on augmentin then doxcy. He goes off within 1 week foot blows up hot red. Been going on few years

    • Dr. Daniel Cameron
      07/09/2019 (1:24 am)

      I also have frustrating cases. I have found other antibiotics effective e.g. treatment for Babesia.I also follow my patients over time to rule out other causes.

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