Is Azithromycin the only antibiotic you can take with Malarone?

Can’t tolerate azithromycin any longer. Will Malarone work if I take it with doxycycline or Bactrim and NOT azithromycin?

Yes, there are other abx you can take with Malarone.

Per LLMD MR:

Atovaquone/proguanil (Malarone) 250 mg/100 mg. Start the atovaquone/proguanil at 2 pills 2 times a day for 3 days, and then decrease to 1 pill 2 times a day. Combine it with one of the following:

Azithromycin (Zithromax) 500 mg 1 time a day,
Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
Doxycycline 100 mg 2 pills 2 times a day, or
Minocycline 100 mg 1 pill 2 times a day.
In addition, if these combinations are not working, add

Sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a four-drug regimen. (Atovaquone/proguanil (Malarone) has two drugs in one pill).
Atovaquone Combinations

Atovaquone (Mepron) 750 mg/5 ml, take 5 ml two times a day. In one to two months, if night sweats or other Babesia symptoms are not improving, then increase the dose to 10 ml two times a day. Combine it with one of the following:

Azithromycin (Zithromax) 500 mg 1 time a day,
Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day,
Doxycycline 100 mg 2 pills 2 times a day, or
Minocycline 100 mg 1 pill 2 times a day.
In addition, if these combinations are not working, add

Sulfamethoxazole/trimethoprim 800 mg/160 mg (Bactrim DS or Septra DS) 1 pill 2 times a day to create a four-drug regimen. (Atovaquone/proguanil (Malarone has two drugs in one pill).
Be sure to take atovaquone with fat because this increases its absorption. Take enough fat so the medicine does not cause nausea or diarrhea. Sources of fat include nuts, nut butter, butter, oils like coconut oil and flaxseed oil, yogurt, cheeses, and avocado.

I found atovaquone + clarithromycin + minocycline + artemisinin quite effective for babesia.

The main side effect was that minocycline is a bit immunosuppressive and tended to make viral infections worse. I got influenza and coronavirus infections repeatedly. Atovaquone works pretty well for treating coronavirus though, so I just took more mepron when I got covid.

I would have stopped the minocycline, but it was the only thing that was really effective against bartonella, so I started taking it again despite the side effect.

I had problems with low folate from malarone (proguanil), but mepron (atovaquone only) doesn't cause this problem. Also got high creatinine from bactrim (trimethoprim) so I had to stop that.

I found that depakote (valproate) was quite effective at killing borrelia and babesia, but I had trouble tolerating that for more than a few weeks at a time, so eventually went back to mepron + abx.

I am so so so happy for you that you are so very close to remission. Yay yay yay!!!!! I called today and spoke with Linda in the office to see if I could get in for an appt also since I’ll be there next week with my son. And fortunately, they were able to squeeze me in, as well. I love my LLMD, but sometimes a fresh set of eyes goes a long way. This recent tick bite (August) is in total remission with meds. But I had to stop due to GI issues and all the sweats and electric sensations through my legs came raging back in two weeks. So clearly the meds are keeping it at bay but certainly not curative.

I’m excited for my son to see their pediatric specialist named Candace. She sounds like she knows her stuff. The good news is I’m coming with all of our labs already done. So there is no guessing game. We know what we have and we just need a solid plan.

If they can’t help me, I will go back to Germany this summer. Although o honesty don’t know if my body can handle the hyperthermia treatment again. I’m older now and more vulnerable with this recent tick bite. Just don’t feel like my constitution is as strong this round, you know?

Anyways, cheers to you and all your efforts and strong will and grit to keep pushing through!!!! Enjoy your wellness!!!!!

Clarithromycin didn't bother my stomach too much, but this is probably due to its much faster elimination compared to azithromycin, so if I just waited a few hours most of it would be gone.

Mepron/malarone didn't seem to bother my stomach much either. Minocycline definitely does hang around long enough to cause diarrhea, and I suspect this would be true of doxycycline also.

Bactrim did seem to hit bartonella, which is notoriously resistant to a lot of antibiotics. However, bartonella releases a toxin when it dies that causes me major stomach upset.