Keys to Antibiotic Therapy

Philosophy or Premise Using An Infectious Model:

Infectious etiology.

• Most rheumatic disease is related to the same process and reacts to antibiotic approach.
• Rheumatic arthritides are an extended acute illness.
• An important mechanism of disease to consider is tissue hypersensitivity.

Organism or Infectious Cause:

• Mycoplasmas, L-forms or other cell-wall deficient forms (here after referred to as mycoplasma) have a pathogenic potential for rheumatic disease.
• Mycoplasmas are symbiotic with host cells
• Mycoplasmas are pleomorphic and mimic their environment: 3 Characteristics: those characteristic of strain those characteristic of a particular host species tissue or media-specific antigens (autoantigens).
• Mycoplasmas create the mechanism of hypersensitivity.
• Disease presentation may be due to particular organism and particular tissues inhabited.

Hypersensitivity:

• Mycoplasmas may not be visible in tissues, as with other hyper- sensitivity diseases. Doesn't fit Koch's Postulates.
• Mycoplasmas are highly allergenic, sensitizing the host.
• Mycoplasmas affinity for certain tissues is dependent upon the tissue and the particular host.
• The created immunopathogenicity is significant for treatment.
• Disease may result from development of immune complexes of unidentified organisms.

Unlocking the Treatment

• Develop a view of the mechanism of disease (using the infectious model) as a framework for treatment.
• THE TREATMENT GOAL is suppression of antigen with the lowest possible dose.
• Treat other focal infections first or concurrently (chlamydia, strep, fungi, etc.).
• The physician addresses the hypersensitivity state of the host.
• THE TREATMENT GUIDELINE is low dose, intermittent spacing. The higher the dose, the wider the space. Scleroderma patients may need a daily regimen (see reference to the "Harvard Protocol" on the web site www.roadback.org Go to "studies" area on pulldown menu and then review the two protocol-related links).
• Dosage is titrated to the degree of sensitivity of the patient: low dose, intermittently spaced antibiotics (titrated as with gold salts or MTX).
• Daily NSAID or other appropriate anti inflammatory may be necessary to suppress inflammation and increase effectiveness of the antibiotics.
• Combination therapy with multiple-acting antibiotics and NSAIDs is often useful. The pharmacodynamics/pharmaco kinetics vary and they attack the organism(s) differently.

The combination:

• NSAID
• Clindamycin was used historically. Other antibiotics now provide additional options.
• Tetracyclines - some macrolides, quinolones
• Combination of routes of administration is sometimes used, especially for certain types of diseases (ie. scleroderma) as well as for some cases of long-standing or severe onset disease. Many patients respond to oral therapy as only treatment.
• Adjunctive treatments might include rehabilitative therapy to maintain mobility and strength (whirlpool, ROM, massage, strengthening exercises), nutritional guidance, stress management etc. Example protocols for educational purposes are posted on The Road Back Foundation web site and elsewhere on the Internet.

The Road Back Foundation does not engage in the practice of medicine. Consult with a physician to assess any medical treatment that is being considered. The Road Back Foundation encourages healthcare consumers to thoroughly investigate and understand all treatments and medications before proceeding. This material is for educational purposes only.