File: faq.txt

[Guest guest]

FREQUENTLY ASKED QUESTIONS ABOUT ANTIBIOTIC THERAPY

1. HOW DOES ANTIBIOTIC THERAPY DIFFER FROM CONVENTIONAL THERAPY?

Antibiotic therapy is based on the theory that inflammatory rheumatic

diseases such as rheumatoid arthritis, scleroderma, lupus, juvenile

rheumatoid arthritis, polymyositis, ankylosing spondylitis, etc. have an

infectious cause, namely mycoplasma and other bacterial L forms. Using low

dose antibiotics, particularly from the tetracycline family, the disease is

attacked at its source. This therapy is equally effective in patients with

severe and/or long standing disease as it is in those with mild to moderate

disease. McPherson Brown, M.D. (1906-1989), a renowned rheumatologist

who practiced in the Washington, D.C. area, pioneered this treatment over

fifty years ago and successfully used it to treat over ten thousand

patients.

The toxic medications used in conventional therapy are prescribed to try and

control or suppress the symptoms. They may or may not work. If they do work,

it is only a matter of time before they either lose their effectiveness or

the patient develops side effects, forcing them to discontinue usage. The

patients often are left worse than before they started the medication.

2. WHAT ANTIBIOTICS ARE USED AND WHAT IS THE DOSAGE?

The ultimate decision about antibiotic therapy for you should be made by

your physician. While this therapy is effective for the majority of

patients, it will not work for everyone. Treatment must be tailored to the

individual patient.

Typically, patients with severe and/or long-standing disease are started

with a series of daily intravenous clindamycin for five to seven days. (Dr.

of Plano, Texas is using lincocin with equal success.) The

first two days, 300 mg. of clindamycin would be administered in 250 cc 0.9%

saline dripped over a 50 to 60 minute period. (D5W is not used because of

the yeast overgrowth found in most of these patients.) The third and fourth

day 600 mg. is given, and the fifth and any subsequent days 900 mg. (A.

Franco, M.D., a rheumatologist in Riverside, California often

prescribes a seven- day series every five weeks four times and then

reassesses the patient's need. In some of his patients with rheumatoid

arthritis, Dr. Franco is substituting Zithromax 250 mg. twice daily two days

a week in place of the IV clindamycin.) After the initial daily series, IVs

may be administered weekly, every other week or as the physician determines

for the individual patient. The IVs are continued until all lab figures

return to normal. Lab figures should then be monitored for a time to be sure

patient remains stable before discontinuing the IVs. For sensitive patients,

a local anesthetic may be applied to the injection site.

Physicians have reported some success using clindamycin orally and in

intramuscular injections. Orally, the single dose is 1200 mg. once a week.

For intramuscular injections, 300 mg to 600 mg. once a week.

When the initial course of IVs is completed, patients begin oral therapy -

minocycline (Minocin) or doxycycline 100 mg. once or twice daily, or

tetracycline 250 mg. to 500 mg. twice daily Monday, Wednesday and Friday.

Tetracycline is more apt to react with food and must be taken on an empty

stomach. The antibiotic and calcium supplements (including dairy products)

should not be taken at the same time. This dosage is effective for most

patients. However, five or even seven-day a week doses may be necessary in

some cases. Patients with mild to moderate disease are started with this

same oral therapy. Some reported sensitivities to the tetracycline drugs may

be caused by the drug being introduced too rapidly and at too high a dose. A

slow start, 50 mg. Monday and Friday then gradually building up to the

standard dose, can often avoid this allergic reaction. Erythromycin can be

substituted for those patients with a sensitivity to the tetracyclines. Some

patients may need to take doxycycline with food. Be careful to avoid dairy

products and calcium supplements. For sensitive stomachs, aloe vera juice

has been found to be helpful - two ounces three to four times a day.

Exacerbation of system lupus erythematosis has been reported in patients

taking minocycline, as has transient lupus-like symptoms. However, while

some physicians report they have not had a problem at the low doses used in

this protocol, other physicians avoid the risk by prescribing erythromycin

for their lupus patients - 333 mg. twice a day Monday, Wednesday and Friday

- taken with food. For those patients with sensitive stomachs, Ery-Tabs may

be prescribed. Erythromycin and clindamycin should not be taken together.

NOTE: An association has been shown between Mycoplasma hominus and lupus.

(Cassell GH, Clough W, Septic Arthritis and Bacteremia Due to Mycoplasma

Resistant to Antimicrobial Therapy in a Patient with Systemic Lupus

Erythematosus, Clin Infec Dis, 1992; 15:402-407). M. hominus is resistant to

erythromycin.

For children under twelve with inflammatory rheumatic disease, EryPed

(erythromycin), is prescribed in place of the tetracycline drugs, to avoid

staining of teeth. The dosage is one teaspoon (200 mg.) three times a day

for 15 to 21 days; then 200 mg. two times a day thereafter, seven days a

week - taken with food. The patient is kept on this medication until three

to six months after labs return to normal. If labs are still normal after

this time, tapering of the drug may begin.

Patients should inform their physician of any adverse reactions to the

medications.

CAUTION: Some oral generic tetracyclines have been found to be ineffective

for this therapy.

McPherson Brown, M.D. et al in Antimycoplasma Approach to the

Mechanism and the Control of Rheumatoid Disease from Inflammatory Diseases

and Copper, The Humana Press 1982 states:

" Intraarticular injections of clindamycin have been very effective when the

reactive state of the joint is so intense that penetrance (of the

antibiotic) is not achieved by the oral or IV route. The inflammation must

be reduced in most instances for maximum clindamycin effect. The usual

treatment plan for large joints, clindamycin 2 cc (300 mg.), plus

dexamethasone 1 cc (4 mg.) A reduced amount of the same combination of these

medications is used for smaller joints. "

" . . . a program of anti-inflammatory medication is essential (except early

in the disease) for the maximum effectiveness of the antibiotic. . . . In

highly allergic individuals antihistamines and even corticosteroids in very

small doses (less than 5 mg. a day) may be necessary to activate the

antimycoplasma medication . . . "

3. IS THERE AN ADVANTAGE TO USING MINOCYCLINE (MINOCIN) OVER THE OTHER

ANTIBIOTICS?

Yes, bacterial cell membranes are surrounded by a lipid layer (a water

insoluble, fatty substance which surrounds the cell and provides it with

fuel. As a means of resisting antibiotics, the cells increase the thickness

of this lipid layer. Minocycline appears to have greater penetrating

ability. It also has an extended spectrum of activity and stays in the

system longer and at higher levels than tetracycline. HOWEVER, there are

patients who have had excellent response using doxycycline and tetracycline.

4. ARE THERE ANY SIDE EFFECTS FROM USING ANTIBIOTICS?

The tetracycline antibiotics taken in low dose, intermittent fashion, can be

used indefinitely without the build-up of tolerance to the drug and without

the serious side effects of conventional drugs. However, as with all

medications, side effects may be encountered. For instance, the antibiotics

can cause yeast infections. Drugs such as the NSAIDS, gold, Plaquenil,

methotrexate, steroids, antibiotics, etc. kill off the necessary good

bacteria in the intestinal tract. Patients should be tested for candida

antibodies at the start of this antibiotic therapy, and if found,

appropriate treatment should be prescribed. Conventional therapy would

include the anti-fungals Nystatin or Diflucan. Natural therapies would

include olive leaf extract (a good product is available from East Park

Research along with slippery elm, l. glutamine and grapefruit seed extract.

(See Section 11 for list of laboratories testing for candida antibodies.) It

is extremely important that patients take a good acidophilus product such as

Metagenics Flora Plus (1-800-638-4362 for distributors) or Flora Source

(1-800-741-4137 for direct purchase) while on this therapy to replace the

good bacteria destroyed by the antibiotics. It is also recommended that

patients avoid direct sunlight while on these antibiotics. Diarrhea is also

listed as a side effect, especially with the clindamycin, but this has not

been encountered at the dosage used in this therapy. Some patients' stomachs

have become sensitized from medications prior to starting this therapy and

may experience nausea. Taking the drug with food (no dairy products) may

help. It has also been found helpful to start with a reduced dosage - 50 mg.

once or twice a week for up to several months, gradually increasing to the

recommended dose.

5. WHAT CAN I EXPECT WHEN STARTING ANTIBIOTICS?

The return to health will normally be a slow, subtle process. In many cases,

the patient will temporarily get worse before getting better but over time,

the flares will decrease in intensity and be spaced further apart until the

infectious agent has been weakened to the point where the patient's immune

system can take over. We call this the two steps backward, three steps

forward process. Patients have reported improvement of their symptoms,

including depression, fatigue, memory, stiff and painful joints, muscle tone

and strength, range of motion, dry, cracked or tight skin, bursitis,

tendonitis, vaculitis due to inflammation, skin ulcers, swallowing

difficulties and heartburn. Patients with Raynaud's symptoms have also

experienced improvement.

6. EXPLAIN THE JARISCH HERXHEIMER REACTION.

This drug-induced flare reaction may occur within hours, the next day or

within the first weeks after the patient starts the antibiotics - or any

time there is a change in antibiotic or dosage. It is caused by a die-off of

organisms, which in turn create toxins that circulate in the body. This will

often cause a worsening of symptoms. Patients may experience a range of

symptoms from mild fatigue and sleepiness to flu-like symptoms - chills, low

grade fever, night sweats, muscle aches, aching and swollen joints, nausea,

hives, skin rashes, depression and short term memory loss. Hives and rash

are sometimes mistaken for an allergic reaction. When this occurs, it is a

good indicator that the antibiotic is reaching its target - a very positive

sign. The length of time for this reaction varies from patient to patient.

About twenty percent of patients do not experience the Herxheimer reaction.

Scleroderma patients seem to experience the Herxheimer reaction less often

than RA patients.

Oxidative therapy may be useful in reducing these symptoms. Garth Nicholson,

M.D., director of The Institute for Molecular Medicine in Huntington Beach,

California recommends peroxide baths (four 16 oz. bottles of 3% hydrogen

peroxide in 20 inch bath or Jacuzzi, with 2 cups of Epsom salt. Patient

soaks in hot water plus the epsom salt for five minutes until pores are

open, then adds the peroxide solution. This should be repeated three times a

week at bedtime. No vitamins should be taken 8 hours before bath. The

peroxide can also be directly applied to the skin after a hot shower/tub.

The peroxide should be left on for 5 minutes and then washed off.

Another useful suggestion from Dr. Nicholson - blend one whole lemon, then

add 1 cup fruit juice or water and 1 tablespoon of olive oil. Strain and

drink liquid.

Diet and supplements are extremely important. Nutritional recommendations

are on this web page and include avoidance of sugar, caffeine, dairy, fatty

or acid forming foods, but an increase in fresh vegetables - especially the

cruciferous vegetables - organic if possible. Patients should drink no less

than two quarts of water a day to flush the toxins out of the system,

lubricate the joints, and carry nutrients through the body; and should have

two to three bowel movements a day.

If the Herxheimer reaction is severe, the medication may be stopped and a

small dose of prednisone (no more than 10 mg.) may be prescribed. When the

flare subsides, the medication is re-introduced at a slow rate.

7. HOW LONG DOES IT TAKE BEFORE I START SEEING IMPROVEMENT?

The length of time a patient has had the disease and the strength of their

immune system will determine the recovery time frame. Some patients see

significant benefits in months, but for others it may take several years.

Dr. Pnina Langevitz of Israel reported that the longer patients stayed on

the antibiotics the greater improvement they experienced. Patients can

safely remain on these antibiotics for years without building up resistance

to them.

8. CAN I EXPECT TO BE ABLE TO DISCONTINUE MEDICATION EVENTUALLY?

Some patients may find this treatment provides a permanent remission and no

further medication is needed, but most will need to stay on a maintenance

dose to keep the disease under control. If symptoms should return at any

time a short course of 100 mg. of minocycline or doxycycline, or 500 mg to

1,000 mg. of tetracycline three times a day for three days will usually

re-establish the remission for an indefinite period. For some patients a

return to normal lab figures occurs before they reach a symptom free

remission. For others the reverse is true - the symptoms leave first and

then the lab figures return to normal.

9. WHY ARE THE IVs NECESSARY IN SEVERE OR LONG STANDING DISEASE?

In severe or long standing disease, or in very resistant cases, the oral

route may be inadequate for the antibiotic to reach its target and suppress

antigen formation. The intravenous clindamycin would then be required. The

IV clindamycin jump-starts the therapy, eradicating long-standing

microorganisms in the gut, respiratory tract and other areas, creating

greater receptivity for the tetracycline drug.

IV clindamycin therapy is recommended in the treatment of all scleroderma

patients from mild to severe. When lab figures return to normal, these

patients may still require occasional IVs or a weekly dose of oral

clindamycin to remain stable.

10. WHAT LAB TESTS SHOULD BE DONE TO MONITOR MY PROGRESS?

Laboratory tests are done to help in the diagnosis of the disease and to

provide a baseline from which to measure progress after antibiotic therapy

has begun. These include a complete blood count (CBC), rheumatoid factor

(RF), erythrocyte sedimentation rate (ESR), C reactive protein (CRP),

antinuclear antibody (ANA), antistreptolysin-O titer (ASO), and mycoplasma

complement fixation (MCF). These tests can be repeated at your doctor's

discretion to follow your progress.

Running an ASO titer is very important. If elevated, amoxicillin or

ampicillin is prescribed. Once the ASO titer returns to normal, patient

should be monitored for recurrence. Some patients may need to stay on

medication until a negative titer is achieved.

11. I HAVE BEEN ON 100 MG. OF MINOCYCLINE MONDAY, WEDNESDAY AND FRIDAY FOR

SIX MONTHS AND HAVE SEEN NO RESPONSE. CAN I STILL EXPECT IMPROVEMENT?

Yes, however you should have some indication by this time that the

antibiotic is working for you. Your doctor needs to do a little detective

work at this point. Here are some things to check:

a. Laboratory tests should be run again. Often improvement in these tests

will precede improvement of symptoms.

b. If you are on a generic minocycline, change manufacturers or switch to

the brand name. Patients have discovered that not all generic minocycline

(or doxycycline) is therapeutically equivalent. Many physicians prescribe

the brand name to avoid this risk.

c. Try a different antibiotic. All patients may not respond to minocycline

(Minocin).

d. Try one antibiotic in the morning and a different one at night, or

sequence them taking one for six weeks and then switching to another for six

weeks.

e. If your disease is severe, long standing or very resistant, and you are

only on oral antibiotics, you will need to add intravenous therapy.

f. Look for other infections in the sinuses, allergies, root canals,

intestinal tract, etc. that may be impeding your progress and must be

addressed for optimum benefit from this therapy. The first area to check is

the intestinal tract for candida overgrowth and leaky gut. There are special

labs that perform these tests - Immuno-Science Lab in Beverly Hills, CA.

(http://www.immuno-sci-lab.com), and Antibody Assay Laboratories in Santa

Ana, CA. (phone -800-522-2611) run candida antibody tests, and Great Smokies

Lab runs the lactulose mannitol test for leaky gut. (http://www.gsdl.com or

http://www.greatsmokies-lab.com)

g. Did you have an elevated ASO titer? If so, it must be treated as well.

The strep organism is difficult to eradicate and even after the ASO titer

returns to normal, the patient should be monitored for some time for

recurrence. The goal of the therapy is to remove antigen wherever it may be

found in the body in order to achieve optimum benefit from this therapy.

h. Are you deficient in antibody? Perhaps intravenous immunoglobulin is

necessary.

i. Did your doctor have the mycoplasma test run? It should be run for the

entire panel and not just for M. pneumoniae. The first test may be negative

if the immune system is too weak to mount an antibody attack to the

organism. Therefore, it is important to repeat the test within 3 to 6

months. If it is still negative, the medication should be changed. The

tetracycline antibiotic still works in some instances of a negative reading.

If the cause is viral the antibiotic therapy may fail. Additionally, the

cause could be streptococcus infection compounded with a mycoplasma

infection or vice versa.

Three laboratories performing this special testing are listed on this web

site in the Doctors' Corner.

12. MY DOCTOR HAS TOLD ME TO STOP THE MINOCYCLINE (MINOCIN) BECAUSE OF A LOW

WHITE BLOOD COUNT.

White blood cells are used to fight infection. A low white blood cell count

is clinically called leukopenia. This occurs when there is a reduction in

the normal number of circulating white blood cells in the blood stream. This

condition involves the blood and the bone marrow. Patients may demonstrate a

low white cell count before commencing the antibiotics. This can be due to

the nature of their illness, or previous therapy such as methotrexate that

causes suppression of white blood cells, platelets and red blood cells. This

is caused by increased destruction or impaired production of these cells.

Poor quality protein intake or digestion (impaired pancreatic enzyme or HCI

production), inadequate trace mineral or essential fatty acid intake are

other causes.

A blood test called the Carbon test (800-722-8327) is enormously helpful at

determining the cause of the decreased WBC. The company can provide a

clinician that can perform the test in your area.

A doctor may be cautious and suggest that you cease the minocycline therapy.

This is to check that this is not the trigger of the leukopenia. If the

white count returns to normal then one can resume the minocycline and

observe if the WBC count decreases again. If it decreases again it probably

is not wise to continue with the Minocin.

The minocycline assists the body in clearing the infection and once the

infectious trigger which stimulates the increased production of white blood

cells is gone, the WBC will drop to its normal non-infectious level.

13. MY DOCTOR HAS ME ON METHOTREXATE. DO I STAY ON THIS MEDICATION ALONG

WITH THE ANTIBIOTICS?

Physicians should be cautious about possible antagonism between drugs, which

could cause severe side effects. Response to antibiotic therapy depends to a

large degree on the strength of the immune system. Methotrexate is a toxic,

immune-suppressing drug, and physicians most experienced in the use of this

therapy take patients off the drug. Ideally, a six week wash out period is

recommended between stopping the methotrexate and starting the antibiotic

therapy.

However, if you are receiving benefit from the methotrexate, your physician

may be reluctant to discontinue it. The antibiotic therapy can be started

and then eventually gradually the patient is tapered off the drug. If you

are receiving no benefit from the methotrexate, it should be discontinued.

14. DOES THIS TREATMENT WORK FOR FIBROMYALGIA?

Garth Nicholson, M.D. of the Institute of Molecular Medicine at Huntington

Beach, CA., and Daryl See, M.D. of the University of California College of

Medicine at Irvine, CA are finding strong evidence of mycoplasmal blood

infections in a majority of their fibromyalgia patients. Other chronic

infections may also be a source. They recommend long term antibiotic

therapy. Click here for further information from Dr. Nicholson.

Dr. Lida Mattman, a leading microbiologist, retired from Wayne State

University and now running a laboratory with Dr. Seldon in Warren,

Michigan, reports she is finding the Lyme Disease spirochete, Borrelia

burgdorferi in 40% of the fibromyalgia patients she tests. Dr. Mattman says

should the strep organism be causing a problem, it will not be found until

the Lyme Disease is treated - these organisms overgrow each other. Posted in

the section of our web page titled " Interesting Topics " is another program

used by a fibromyalgia patient that put her disease in remission.

15. GENERAL INFORMATION

a)From the Physicians' Desk Reference:

" Concurrent use of tetracycline may render oral contraceptives less

effective. "

" Minocin pellet-filled capsules, like other tetracycline-class antibiotics,

can cause fetal harm when administered to a pregnant woman. . . . The use of

drugs of the tetracycline class during tooth development (last half of

pregnancy, infancy, and childhood to the age of 8 years) may cause permanent

discoloration of the teeth (yellow-gray-brown). "

List of supplies need for intravenous infusion.

900 mg. vials of Cleocin or clindamycin

250cc 0.9%NS or lactated ringers. D5W should not be used because of the

candida overgrowth found in these patients.

10cc syringe with 21 gauge needle to draw up medication and insert in

delivery solution.

IV tubing set

IV needle or catheter (recommend 23gauge butterfly). Always ask for extras.

Tourniquet, antiseptic pads, bandaids, and tape (paper, silk, or adhesive).

Sometimes these are available as an " IV start kit " .

Our thanks to Dr. M. R. Coker-Vann, Ph.D.

Director, Arthritis Research Center

504 E. Diamond Ave.

Gathersburg, MD 20877

Phone: 301-216-1231

for her assistance in compiling the answers to the above questions. Dr.

Coker-Vann was research director of Dr. McPherson Brown's Arthritis

Institute at the time of his death in 1989.

First revision May 1998

Second revision July 1999

* IMPORTANT MESSAGE from A. Franco, MD, Arthritis Center of

Riverside, Riverside, California.

Dear Patients,

I often find that patients that come to see me for diagnosis and treatment

for rheumatic diseases have already started on antibiotic treatment.

Although this may be helpful to the patient, it would be best when

applicable to have the appropriate work-up PRIOR to starting antibiotic

treatment. I am referring especially to the mycoplasma and Chlamydia PCR

test (generic fingerprint).

Antibiotics may render this test negative and thereby often making useless

this great diagnostic tool, especially in view of the fact that patients

will be obligated to use antibiotics for several years exposing themselves

to some potential toxic side effects. If you have already started

antibiotics, you should continue and consider going off for 4 weeks prior to

your visit to the Arthritis Center of Riverside, or your physician's office

where these tests may be done.

If it is possible to do the above, you will increase your chances of

confirming the infectious cause of your rheumatic disease. Even more so by

doing the test prior to initiating antibiotic treatment. Additionally, your

insurance company will be more likely to authorize and pay for IV treatment

if you have a positive mycoplasma PCR test.

I hope this information proves useful to you.

Sincerely, A. Franco, MD

------------------------------------------------------------------------

Please click here to go back to the main page