ZITHROMAX / AZITHROMYCIN
Updated: Oct 21
I gathered the top mentions of azithromycin and how it is used against Lyme, Babesia, Bartonella and more. I used it in an IV.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
WHAT IS AZITHROMYCIN?
-Azithromycin (brand name Zithromax) is a prescription antibiotic in the macrolide family.
-It comes as a tablet or a liquid, and some doctors give it by IV, like I had.
-Many Lyme doctors, including Dr. Marty Ross, feel that combinations work better than one antibiotic alone, so azithromycin is usually paired with something else.
-Dr. Ross also shares that azithromycin is one antibiotic he does not pulse (take on and off).
AZITHROMYCIN AND BABESIA
-For Babesia, azithromycin is most often paired with atovaquone (Mepron), or with Malarone, which contains atovaquone.
-In a 2024 Yale School of Public Health article, a Tufts Medical Center researcher called atovaquone plus azithromycin the standard two-drug pairing and said it works for nearly everyone with a mild case.
-Dr. Marty Ross lists azithromycin as one of the partners he uses with Malarone or Mepron.
-Every Lyme doctor has their own approach, and that's okay. What you use is between you and your doctor.
AZITHROMYCIN AND BARTONELLA
-In a 2020 Johns Hopkins lab study from Dr. Ying Zhang's group, four antibiotic pairs killed the hard-to-treat "resting" form of Bartonella within one day. Two of them used azithromycin: azithromycin with methylene blue, and azithromycin with ciprofloxacin. The other two were rifampin with methylene blue, and rifampin with ciprofloxacin.
-The same four pairs also cleared Bartonella from biofilms (protective slime layers) after 6 days of treatment.
-In a 2021 lab study funded in part by Bay Area Lyme Foundation, doxycycline and azithromycin used alone did about the same as no drug at all against the persistent form of Bartonella.
-These were lab studies, so human studies are still needed.
-Dr. Marty Ross uses azithromycin in several of his Bartonella combinations.
PLEASE BE CAREFUL
-Common side effects include nausea, vomiting, diarrhea, stomach pain and headache.
-Azithromycin can affect heart rhythm (a problem called a prolonged QT interval). Tell your doctor if you or anyone in your family has had this or an irregular heartbeat, or if you have low potassium or magnesium. Ask your doctor whether you need an EKG first, especially if you take other medicines that affect heart rhythm.
-Call your doctor right away if you have a fast, pounding or irregular heartbeat, yellow skin or eyes, or severe watery or bloody diarrhea (this can happen up to 2 months or more after you finish).
-If you take an antacid with aluminum or magnesium, ask your doctor or pharmacist how many hours apart to take it.
-Tell your doctor if you have liver or kidney disease, or if you are pregnant, planning to become pregnant or breastfeeding.
-Dr. Ross shares that it's very common to feel worse for a while after starting or switching an antibiotic, often from a herx (die-off) reaction.
-Probiotics are usually taken 2 to 3 hours apart from antibiotics (Saccharomyces boulardii is the exception). See my probiotics post below.
RELATED POSTS
Babesia - Possible Solutions
Babesia (education)
Babesia Odocoilei
Babesia Directory
Malarone / Atovaquone
Alinia
Bartonella
Bartonella - Possible Solutions
Antibiotics - Why Using Only One Is Not Recommended in Chronic Lyme
https://www.riseabovelyme.com/post/antibiotics-why-using-only-one-is-not-recommended-in-chronic-lyme
Pulsing Antibiotics
PICC Lines / IV Antibiotics
Methylene Blue
Probiotics and Saccharomyces Boulardii
Herx - Possible Solutions
SOURCES
MedlinePlus - Azithromycin - NIH National Library of Medicine (May 2026)
Yale School of Public Health - Antimalarial drug is effective against tick-borne infection babesiosis (May 2024)
Bay Area Lyme Foundation - Herbal medicines demonstrate potency against Bartonella, lab study (August 2021, older source, still worth reading)
Johns Hopkins University - Effect of different drugs and drug combinations on killing stationary phase and biofilm Bartonella henselae, lab study in BMC Microbiology (April 2020, older source, still worth reading)
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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