ANTIBIOTIC PROTOCOL FOR RHEUMATIC DISEASES
INTRODUCTION
DR. THOMAS McPHERSON BROWN'S THEORY, RESEARCH & THERAPY
BEGINNING THE ANTIBIOTIC THERAPY
CLINDAMYCIN BY INJECTION
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
ANCILLARY PAIN MANAGEMENT
HERXHEIMER REACTION
MYCOPLASMA INFECTIONS
MYCOPLASMA SPECIES: RESPONSE TO ANTIMICROBIALS
LABORATORY TESTS
CANDIDA INFECTIONS
NUTRITION & SUPPLEMENTS
EXERCISE
DEPRESSION
REMISSION
INTRODUCTION
As a conventional and alternative doctor, I try to offer the best of both treatments to my patients. Rheumatoid arthritis is a chronic and debilitating disease. Approximately two million people are affected. There are different degrees of this disease from mild, moderate to severe. It causes inflammation of joints, swelling, fatigue, anemia, stiffness, and pain. Onset may be at any age but most often occurs between twenty-five and fifty years of age. It can develop suddenly or slowly over years. After acute flares, the joint inflammation becomes chronic with intermittent episodes of acute exacerbations, mediated by the reaction of our own immune system. Although the initial triggering event starting this process has been debated for decades, evidence has been accumulating which implicates an infectious etiology.
DR. THOMAS McPHERSON BROWN'S: THEORY, RESEARCH & THERAPY
In 1998, I attended the Road Back Foundation's seminar in New York City and was very impressed with the theory of the late Thomas McPherson Brown, M.D. His research was at the National Institutes of Health, Johns Hopkins and the Rockefeller Institute.
Dr. Brown used antibiotic therapy to treat rheumatoid disease based on the belief that arthritis is caused by an infection of mycoplasma or L-forms (organisms without a normal bacterial surface membrane). His theory was that these microorganisms, as they multiply or die, release toxins that cause an inflammatory reaction in the body. Presumably, the body produces antibodies to these invading organisms. These antibodies become trapped within the joint fluid. The body's white cells invade the joint to engulf these antibodies, which do not normally belong in joint fluid. The joint inflammation and destruction occurs as a consequence of these white cells releasing enzymes which partially digests joint structures producing the disfigurement of rheumatoid arthritis. If the mycoplasmal infection is eradicated by antibiotic therapy, the immune inflammatory reaction ceases.
BEGINNING THE ANTIBIOTIC THERAPY
Long-term, low-dose tetracyclines are known for their relative lack of toxic side effects. Minocin/minocycline appears to be the drug of choice because of its penetration, broad antibiotic spectrum and sustained tissue levels. Other patients have had excellent responses to Vibramycin/doxycycline or Tetracycline. To begin antibiotic therapy, patients must be advised that dosing is low and increased very gradually. It may take six months to over a year before patients can see any benefits. Long standing or severe rheumatoid arthritis can take even longer (2 to 5 years). Too much antibiotic can cause an adverse reaction (Herxheimer's reaction). More is not better. Doses must be titrated very gradually to each person's individual tolerance. There is no single protocol that works for everyone.
Patients with severe or longstanding disease often are started with a series of daily intravenous or intramuscular antibiotic treatments for a period ranging from one to three weeks. Clindamycin is administered to eradicate mycoplasma and L forms of bacteria resident in the respiratory and genitourinary tracts. Following the initial clindamycin administered by injection, the patient is started on oral antibiotics according to the patients tolerance. Typical administrations consist of minocycline or doxycycline with doses ranging between 50 mg to 100 mg or tetracycline 250 mg. The frequency of administration ranges between one dose, one to two days per week to a maximum of twice daily dosing three-times per week. If the medication aggravates the arthritis, then even lower doses and longer dose intervals are required. This should be discussed with your doctor.
CLINDAMYCIN BY INJECTION
For patients with severe or advanced disease, initial intravenous (IV) or intramuscular (IM) therapy may be required. For most patients the therapy begins gradually with clindamycin 300 mg in saline solution administered IV over 45 minutes daily for the first two days. During the next two days, the dose is increased to 600 mg. Thereafter the dose is increased to 900 mg, but only if adverse reactions are not observed. This dose can be continued once daily for one to two weeks, followed by administration of this dose weekly, monthly and ultimately at 6 week intervals.
Clindamycin 300mg can also be delivered IM in the same manner if the patient is having trouble with intravenous administration.
Following the initial clindamycin IV or IM course, oral minocycline or doxycycline is most commonly prescribed. Clindamycin may be continued at intervals as adjunctive therapy. Care should be taken not to administer any antibiotic at too high a dose or too fast to avoid an adverse reaction by the patient.
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
The first step is to reduce the inflammation with anti-inflammatory medications. Two new anti-inflammatory medications are Celebrex and Vioxx (COX 2 INHIBITORS) that do not cause as much stomach irritation. Monitoring for kidney toxicity is precautionary.
ANCILLARY PAIN MANAGEMENT
This depends on the patients needs. Warm baths in epsom salts (2 cups) in a full tub of water may relieve joint pain and stiffness.
HERXHEIMER REACTION
A Herxheimer reaction is a paradoxical aggravation of symptoms following onset of antibiotic therapy. This is more likely to occur if the rheumatoid arthritis is severe. A flare may occur several hours or even weeks after the antibiotic is started. Some patients report transient dizziness when first starting antibiotics. Lowering the dose of the antibiotic and taking it at bedtime is recommended until symptoms resolve. This reaction is believed to be caused by the rapid dying of mycoplasma or other organisms. Patients may experience symptoms ranging from chills to low grade fever, fatigue, flu-like symptoms and further joint swelling. During a severe reaction, the patient should cut back on the dose until the symptoms resolve. A Herxheimer reaction may occur with the initiation of antibiotic therapy or when the antibiotic dose is increased.
MYCOPLASMA INFECTIONS
Dr. Brown was the first physician to isolate mycoplasma from the joint of an arthritic patient. His research was published in Nature in 1939. For the next five decades he treated rheumatoid arthritis as an infectious disease often with great success. Mycoplasma is not a bacteria or virus, but between a virus and bacteria in complexity. Representative strains of mycoplasmas are listed below.
MYCOPLASMA SPECIES: RESPONSE TO ANTIMICROBIALS
Drug susceptibilities need to be tested for each patient's infection if the mycoplasma can be isolated by culture.
M. pneumoniae
M. hominis
U urealticum (genitourinary tract)
M. fementans [incognitis] (genitourinary tract & oropharynx)
Some mycoplasmas such as M. hominis and U urealticum may be found coexisting and may require different antibiotics for eradication.
LABORATORY TESTS
Blood tests should be followed at four to twelve week intervals until the patient stabilizes. Kidney and liver profiles should be performed routinely to assess possible toxicities. Other tests include: CBC, Differential, ESR - Erythrocyte Sedimentation Rate, RF - Rheumatoid Factor, ANA - Antinuclear antibody, MCF - Mycoplasma by Complement Fixation, ASO*, and CRP - C-Reactive Protein.
*Patients with an elevated ASO titer or a strong history of streptococcal infections should be treated - ampicillin 250 mg. daily (but not at the same time as the tetracycline) until the ASO titer returns to normal, and then monitored for recurrence. Failure to treat may compromise the results of this therapy.
CANDIDA INFECTIONS
To prevent Candida (yeast) overgrowth within the gastrointestinal tract during the antibiotic therapy, Acidophilus and Bifidus is recommended as a daily supplement. However, if yeast "superinfection" becomes a significant problem, Nystatin, Diflucan or Sporonox are potential options through your doctor.
NUTRITION & SUPPLEMENTS
A balanced healthy diet is very important to prevent malnutrition and muscle wasting. B vitamins, especially oral B12, has been noted to increase the sense of well-being. Vitamins C and E, fish oils and Primrose oil all may have anti-inflammatory properties. Juicing is an excellent source of natural vitamins.
EXERCISE
Patients should exercise and stretch daily. Moving all the joints is most important to maintain normal range of motion. Light exercises maintain muscle strength and reduce muscle-wasting. Check with your doctor for his recommendations. A physical therapist may also recommend safe exercises for your condition. Aquatic therapy in a warm (84-92 degree F) pool is excellent for maintaining muscle strength through the resistance of water, while allowing full range of joint motion with only partial weight-bearing.
Walking in fresh air and maintaining a positive attitude will help immensely during your course to recovery.
DEPRESSION
Most disturbing is depression. Depression can be devastating. There is usually a loss of interest in outlets such as food, work, friends, hobbies, entertainment and sexual function. Depression is a component of rheumatoid arthritis. As the disease enters remission, the depression resolves. If the depression is severe, your doctor can prescribe anti-depressant medication. The newer ones have far fewer side effects than those prescribed in the past.
REMISSION
During the course of antibiotic therapy, toxic substances are reduced and symptoms resolve gradually. For some patients, treatment provides permanent remission and no further medication is needed. But most patients are required to remain on a maintenance dose of antibiotic to remain in remission.
Dr. Brown, originator of antibiotic therapy, found rotating the antibiotic every four to five years, even within the same class of antibiotic, was advised to prevent the organism from developing resistance. After a period on another antibiotic, the original one may be reinstituted.
Dr. Brown's success rate for remission was approximately 70% with patients in his practice often having failed other therapies before being referred to him.
Protocol for using antibiotics in the treatment of rheumatoid disease is based on publications of Thomas McPherson Brown M.D. and the 1998 protocol of the Road Back Foundation.
References:
January 2001
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