Hi Anno,

If you have The New Arthritis Breakthrough book, there is a section on strep and the importance of treating it. What you could do is bookmark that section to take to your holistic doc to discuss further, being sure to emphasize that Dr Brown found his rheumatic patients did better on AP when they lowered their strep titers. It's those nasty little strep L-forms which are the pain.

Also, there is no need to stop your minocycline while treating the strep if your physician is willing to add in a pulse of azithromycin to your protocol. A number of us here take both minocycline and azithromycin together. Azithromycin is a broad spectrum macrolide antibiotic that is well tolerated alongside the tetracyclines and it is both a bacteriostatic (intracellular actions) and bacteriocidal (interferes with the cell wall of pathogens with cell walls). 

There is also a lot of information under the education tab on the main website where you can print off info about this. If you need help finding this, just let us know. 😉

Peace, Maz 

[user=723]anno[/user] wrote:

Thanks Maz. I looked at the education info & it says 250mg ampicillin every day. I like your idea of azith every 10 days; is there a page that specifically recommends that? (How crazy that we have to teach our drs. how to treat us.)

Hi Anno,

That's an alternative you can try, except that ampicillin is generally contraindicated for use at the same time as the tetracyclines, because apparently tetracyclines prevents ampicillin from working effectively. Don't quote me on this, but I believe I also read somewhere that the penicillins used consecutively with tetracyclines puts a heavy burden on the kidneys, which can result in renal hypertension in a “worst case scenario.”

Here is a link to drug interactions with ampicillin. Minocycline/Minocin are listed as “moderate” in terms of these interactions:

http://www.drugs.com/drug-interactions/ampicillin_d00003.html

Here is a link discussing how ampicillin's effectiveness is reduced by the tetracyclines:

https://www.changehealthcare.com/rx_brands/drug_interactions/893

“Generally avoid – Moderate drug interaction with Adoxa, Adoxa CK, Adoxa TT, Ala-Tet, Alodox, Declomycin, Demeclocycline Hydrochloride, Doryx, Doxycycline Hyclate, Doxycycline Monohydrate, Dynacin, Minocin, Minocin PAC, Minocycline Hydrochloride, Monodox, Myrac, Oracea, Oraxyl, Periostat, Solodyn, Sumycin, Tetracycline Hydrochloride, Vibra-Tabs, Vibramycin, Vibramycin Calcium, and Vibramycin Monohydrate

[*]
[/*]GENERALLY AVOID: Tetracyclines may reduce the effect of penicillins by inhibiting cellular protein synthesis which is necessary for cell wall synthesis inhibition by penicillins. Antagonism is more likely when low doses of either agent are administered. Therapeutic failure may result. MANAGEMENT: This combination should be avoided if possible.”

Here is a link to azithromycin in Wikipedia:

http://en.wikipedia.org/wiki/Azithromycin

You'll see a list of all the organisms which zith targets, which also include some of the mycoplasma and chlamydiae species, so it makes a nice complement to the tetracycline and gives it a bit of a boost, so to speak. The penicillins, on the other hand, don't affect cell wall deficient bacteria (CWDs), because they are cell wall-less.

The dose you'd need would depend on what your doc thinks best for you. I started out on two zith on my mino off days (Tues and Thurs), but this caused heavy herxing, regular as clockwork about the third or fourth day after each dosing. I have Lyme disease and this manifested as palpitations, as Lyme can affect heart tissue. So, I backed off my zith dose and spaced it further apart with my physician's permission and the lower dose with wider pulses has worked well for me. In terms of bringing down strep titers, you may have to go with a different dosing schedule until you can get the titers down, but hopefully that will something you can work out with your doc, if he's open to helping you in this way. Fingers crossed!

Peace, Maz  

Hi Anno,

I just re-read the above and forgot to answer where you can find info on the azithromycin for your doc! 😕 

If you go to this link and scroll down to FAQ #13 Point (c), you will find Dr F's (Riverside, CA – experienced AP doc) recommendations for adding azithromycin:

http://rheumatic.org/faq.htm

c. Try a different antibiotic. All patients may not respond to minocycline or doxycline. Some physicians add Zithromax. If you are taking the minocycline Monday, Wednesday and Friday, the dose for the Zithromax is 250 mg. twice daily Tuesday and Thursday.
(Adding an anti-fungal may be necessary. There have been reports of success using the combination Minocin, Flagyl and Nystatin. The liver should be monitored closely when using anti-fungals.)

Also, just above this in FAQ #12, the last line of the paragraph, Dr F says this about strep:

“If a patient had a history of strep, Dr. Brown would prescribe amoxicillin or ampicillin even in the absence of a positive titer. According to published research oral clindamycin is superior to either penicillin or other antibiotics because clindamycin best inhibits the 'encapsulated' form of streptococcus.”

So, another alternative you could ask your doc about is about oral clindamycin. Have to say, my personal preference, as just a fellow patient, is azithromycin (which is also in the same “mycin” family), because as I understand it oral clindy can be very hard on the gut in higher, longerm doses and has been strongly linked to clostridium difficile infection. If the doc uses smaller, pulsed doses this might be just fine.

I think the thing is that you have alternatives that you could do some therapeutic probes on, anyway, with your doc's help. You could ask about ampicillin and do it the original Dr Brown way, but it's never been clear to me whether he used ampicillin concomittantly with the tetracyclines or whether he took patients off the tetracycline to treat the strep separately. I think I'd personally want to err on the side of caution and not take them together. Maybe someone here has some insight about this if they have used this protocol with their AP doc?

Whatever route you choose, just by virtue of the fact that you're increasing your antbiotic intake, you will have to be on guard for candida. So being really consistent with your probiotics and careful with diet (eliminating sugars) will be really important. 😉 Above, Dr F even suggests adding in an anti-fungal, but close liver monitoring is important.

All the best in your decision-making process, Anno…do hope I haven't confused the issue with all the alternatives above, but I'd forgotten to refer you to the rheumatic.org FAQs, as well.

Peace, Maz