Resources
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Why Antibiotics?
For decades, researchers and physicians have explored the possibility that certain chronic inflammatory and autoimmune diseases may be influenced by infections or microbial triggers in susceptible individuals. This idea is not new. As early as the 1930s, physician and researcher Thomas McPherson Brown observed that some patients with rheumatoid arthritis and related diseases improved when treated with specific antibiotics. His work led to the development of what is now commonly known as Antibiotic Protocol (AP) therapy. The antibiotics most commonly used in AP therapy, including tetracycline-class medications such as minocycline and doxycycline, are believed to offer benefits in two ways:
- Antimicrobial Effects
Some researchers believe that underlying bacterial infections, microbial imbalances, or persistent infectious triggers may contribute to inflammation in certain individuals. Antibiotics may help reduce these potential triggers.
- Anti-Inflammatory and Immune-Modulating Effects
Tetracycline antibiotics have been shown to possess anti-inflammatory and immune-modulating properties independent of their antimicrobial activity. These medications may help regulate inflammatory pathways, reduce tissue-destructive enzymes, and support the body’s ability to control inflammation. Today, antibiotic therapy remains an option that some physicians use as part of a comprehensive treatment approach for rheumatoid arthritis, scleroderma, and other rheumatic diseases. Research continues to explore the complex relationship between infection, the microbiome, immune system function, and chronic inflammatory disease. While antibiotic therapy might not be appropriate for every patient, many individuals have reported significant improvement using this approach under the guidance of a knowledgeable physician. The Road Back Foundation is dedicated to providing educational resources, research, physician information, and patient experiences so that individuals can make informed decisions about their treatment options in partnership with their healthcare providers.
Protocols
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Pulsed Antibiotic Protocol and Rationale
Sometimes referred to as the Historical Protocol, this approach by Dr. Brown was based on the anti-microbial effects of the tetracyclines: tetracycline, doxycycline and, later, minocycline, which became the tetracycline of choice due to its superior tissue penetration and ability to cross the blood-brain barrier.
Brown opted to treat in pulsed doses due to the slow replication of mycoplasma (his primary area of focus), because it’s an organism that doesn’t require a constant attack by the antibiotic. He also titrated the dose to individual patient tolerance, given that many people with inflammatory forms of arthritis can sometimes experience an extreme Jarisch-Herxheimer reaction that is counter-productive, as severe inflammation prevents the antibiotic from reaching its target.
The protocol that follows was compiled in 1998 as an online resource for patients and physicians.
Click here to read about the pulsed protocol and rationale.
Daily Antibiotic Protocol (‘Harvard Protocol’)
The material at the link below comprises a review of what has become known as The Harvard Protocol. The Harvard Protocol is so named because of the NIH-sponsored MIRA (Minocycline in Rheumatoid Arthritis) trials which were run out of Beth Israel Deaconess Hospital in Boston in 1995.
In these trials, Minocycline was researched as to whether it is a safe and effective DMARD (Disease-Modifying Anti-Rheumatic Drug), rather than for its anti-microbial properties.
Click here to read about the “Harvard” protocol and rationale.