A Conceptual View of Antibiotic Therapy

Many of us are resistant to different ideas until we can objectively view, rationally comprehend or mentally picture the new concept being offered. This is also true of approaches to medicine. Antibiotic therapy is such an approach. It is not new, but it is different from the traditional treatment of rheumatic diseases. Antibiotic therapy, in this article, is understood to be that based on tetracycline and certain other drugs which are antimycoplasmic.

Successful treatment of rheumatic diseases with antibiotic (tetracycline, etc.) therapy is more than prescribing a standard dose of antibiotic to every patient and then expecting somewhat uniform results. This is true of treating anything else as well. But antibiotic therapy necessitates treatment and prescribing from a conceptual view of the disease mechanism in order to be able to properly titer the dose and deal with individual expressions and differences in patients' diseases.

A Conceptual View

The concept is based on the premise that no major disease was ever understood or conquered until its cause had been identified. A great deal of published literature supports the fact that mycoplasma and bacterial L-forms are now recognized as being widely distributed throughout nature, as having a precise affinity for joint tissue and are known to produce arthritis in a variety of species including rats and mice, cattle, swine, gorillas and elephants. As one ascends the phylogenic scale, tissue hypersensitivity or reactivity becomes an extremely important part of the defense mechanism against infection. Both mycoplasmas and L-forms promote a high degree of tissue hypersensitivity in a manner comparable to the tubercle bacillus, the brucella organism and the beta-hemolytic streptococcus.

Conceptual Treatment

* While dealing with the hypersensitive state of the human host, suppress the antigen through inhibiting mycoplasma growth, replication and DNAse.

* Understanding that the hyper-sensitivity state is itself anti-microbial (as with an asthmatic) and that this is the design of the immune system.

* Remembering that in a highly reactive state, antigen is already suppressed, therefore very little antimicrobial medication is needed for further control.

* While understanding that with too much medication, the body reacts to the medication itself, and this defeats the purpose of treatment. All bacterial hypersensitivity states require intermittent antigen suppressing treatment. This is standard for treatment of tuberculosis with streptomycin; tetracycline for chronic brucellosis; gold for rheumatic diseases; penicillin for chronic rheumatic fever or methotrexate for rheumatoid diseases.

Treatment Approach

* Focus on an antigen trigger.

* Pursue treatment long enough to eventually suppress antigen formation, Improvement may not be seen quickly. It is frequently 6 months to 1 year before there is evidence of significant improvement.

* Give antimicrobial medication in conjunction with antiinflammatory medication in order to reach beyond the inflammatory barrier to the source of antigen production.

* Tetracyclines by themselves are sometimes ineffective without preparing the way for their modes of action. NSAIDs reduce the inflammatory barrier without depressing the immune system. Probiotics may be used to protect the GI tract.

Benefit vs Risk

* Tetracyclines are not accumulative (as is gold - a single shot of gold stays in the system at least a year) & anti-malarials. If delayed sensitivity to the drug develops, it is easily countered by stopping the antibiotic for a short time (a week) without losing the benefits already gained.

* Tetracyclines affect the soma of the microbe rather than the cell-wall, thus drug resistance is rarely a problem. Their sensitizing effect, as judged by their long-term use in the treatment of acne and broncheostasis, is [generally] nil.

* Initiation of all antimycoplasma medications such as tetracycline (as well as gold salts, Plaquenil or chloroquine) can produce a flare reaction: the Herxheimer reaction. This reaction is [often] treatable by reduction in dose of the antibiotic.

* Once reduction of mycoplasma antigen (remission) is established, it can be maintained indefinitely except for occasional non-damaging flares associated with seasonal changes, stress, infection, trauma or other environmental factors which allow a resurgence of antigen.

[Some]other drugs that have proven effective with this treatment are: clindamycin, lincomycin, azithromax, cefuroxime and erythromycin.

Knowledge of the entire spectrum of pharmacodynamic effects of an antimicrobial is an important prerequisite to understanding how it can be optimally administered to patients.

WA Craig et al,

Scand. J Rheu, 1991,

Supp 74, pg. 69