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The drug of choice to treat BLO is levofloxacin. Levofloxacin is usually never used for Lyme or Babesia, so many patients who have tick-borne diseases, and who have been treated for them but remain ill, may in fact be infected with BLO.

Treatment consist of 500 mg daily (may be adjusted based on body weight) for at least one month. Treat for three months or longer in the more ill patient.

It has been suggested that levofloxacin may be more effective in treating this infection if a proton pump inhibitor is added in standard doses.

Another subtlety is that certain antibiotic combinations seem to inhibit the action of levofloxacin, while others seem to be neutral.

I advise against using an erythromycin-like drug, as clinically such patients do poorly.

On the other hand, combinations with cephalosporins, penicillins and tetracyclines are okay. Alternatives to levofloxacin include rifampin, gentamicin and possibly streptomycin.

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