Things to Check if You are not Seeing Improvement on Antibiotic Therapy
If you have been using antibiotics for an inflammatory rheumatic disease for some time and are not seeing the improvement you and your doctor had anticipated, it may be time to do some medical detective work. Other factors may be involved. The following list contains some of the contributing factors which other patients and physicians have found, through experience, to affect the response of rheumatic diseases to antibiotics.
1. How long have you had rheumatoid arthritis (RA), lupus, scleroderma, etc.?
Tissues of a rheumatic patient are often very sensitive; they react to medication. An early case may accept medication much more readily than an advanced case. If you have had your rheumatic disease for years, you may need to go slowly with the medications, or your body might respond with a severe flare. As your body adjusts, the dose can be slowly increased to the widely used protocol of 3 times a week (M-W-F) or even daily. However, it has been reported that many scleroderma patients benefit from the daily dosages given in the clinical trials, a treatment sometimes referred to as The Harvard Protocol.
Often, the longer the duration of the disease, the longer the time before improvement will be noted.
2. Were there any other pre-existing conditions prior to the commencement of the antibiotic treatment? e.g. Diabetes, allergies, chronic infections, yeast issues, hormone imbalances etc?
These conditions must be addressed to obtain optimum success of the antibiotic treatment.
3. Are you on any other medications prescribed by a physician or bought over the counter?
Drugs taken for other conditions may be antagonistic to the antibiotics used in this therapy so you and your physician will need to address that possibility.
Giving temporary symptomatic relief does not address the source of the disease.
4. Are you allergic to tetracycline?
Possibly another tetracycline such as Minocin (minocycline), Vibramycin (doxycycline) or Sumycin (tetracycline) can be used. In some cases erythromycin is used, especially in young children where tetracycline can stain teeth.
If the patients stomach is highly sensitive to oral medications, IV (intravenous) or IM (injection) may be needed to be substituted temporarily. Early cases respond well to oral tetracyclines, while long-standing disease, in some cases, responds better to combination IV/oral therapy.
5. Why are low doses used, and for such a long period?
This treatment is effective in part, because of the long standing theory that a microorganism is involved. It builds up a wall of inflammation around it in response to the toxins it produces --which keep antibiotics from reaching and destroying it. The tetracycline suppresses this toxin production, slowly destroying this organism's defense mechanism and eventually allowing the antibiotic to put the disease into remission. When this treatment is not followed, the organism can remain in the patient for years, and a remission is difficult to achieve or maintain.
Other theories as to the efficacy of using antibiotic therapy include the influence of the anti-inflammatory component of some of these drugs.
6. Have there been any significant changes in your blood tests (SED rate, rheumatoid factor, hemoglobin, hematocrit, gamma globulin, liver function, MCF, ANA, CRP, and ASO) during the course of the antibiotic treatment?
Blood tests should be performed routinely to determine the activity level of the disease and to measure improvement. Some blood values may worsen during the early stages of the treatment. If the numbers improve, there is improvement in your disease although you may not feel it at first. There is often a time lag between how you feel and your lab results. A change in either one often means you can expect a change in the other.
7. Correspondingly, if there is no change in your laboratory numbers, other factors need to be considered.
How soon you experience a change is a very individual thing. Patient response time varies anywhere from immediate to as long as 3-5 years. Men often respond faster than women, and children faster than adults. Your physician should look for secondary infections (e.g. strep, chronic sinus infections, yeast, or fungi, etc.) as these often need to be treated before the rheumatic disease will improve significantly.
Sometimes mycoplasma and strep coexist together. If an ASO for strep titer is performed, many rheumatic disease patients test positive. The strep needs to be treated with an appropriate antibiotic for the rheumatic disease to respond.
Treating hormone imbalances or boosting a depressed immune system can significantly increase treatment response.
8. Some patients experience a Jarisch Herxheimer reaction, a flare at the onset of treatment induced by the medication.
This is often a good indicator of the activity of the drug, and during which time blood values may worsen. The length of time for this reaction varies with individual patients.
9. If you are not seeing improvement, does your physician think that a lower (or higher) dosage of the antibiotic would help? Perhaps a change in antibiotic? IVs?
10. Are you taking a generic version of the antibiotic? Some generic versions are not effective at these low doses.
11. Are you expecting change too soon?
If your disease is of short term duration, and you see no significant improvement in either test results or symptoms in a six month time frame (and examination has indicated no other factors), it may be beneficial to change the antibiotic (ie.Minocin (minocycline) to Vibramycin (doxycycline) or to a different family of antibiotics such as Zithromax or Ceftin) depending upon which is indicated. While the duration of the treatment will vary from patient to patient, it is usually quite lengthy, sometimes requiring patients to remain on low doses of antibiotics for years for maximum benefit. Antibiotics are generally administered orally to patients diagnosed in the early stages of the disease. More advanced cases sometimes respond well if antibiotics are administered intravenously as well as orally for maximum benefit.
12. What about the stress in your life?
Stress will aggravate your symptoms, which, in turn, will delay the benefits of this therapy. Emotions such as anger, hostility, maladjustment, fear, and a negative outlook can impair immune system function. You need to find a way to break the cycles of negative emotions, tensions, and pain.
Depression is a symptom of rheumatic disease and will often improve as treatment begins to take effect. It does not necessarily mean you are handling your disease badly. The last thing patients with rheumatic disease need is to feel guilty that they are depressed about having a disease that they are told is incurable.
13. Consider adjunct therapies such as exercise, whirlpool baths, massage, swimming, proper nutrition and supplementation suggested by a professional to support the immune system function.
14. It is thought by some that there are patients who have multiple organisms that contribute to their disease. When one organism is removed, others overgrow causing new symptoms. Identifying and treating them can increase response to treatment and lessen symptoms.
15. Anti-inflammatories should be used when indicated to prevent the inflammation from creating a barrier which the antibiotic cannot penetrate.
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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.
The Road Back Foundation
P.O. Box 410184
Cambridge, MA 02141
614-227-1556
www.roadback.org
