Relapsing need some advice

[PhilC]

The fact that mycoplasma are cell wall-deficient bacteria has no bearing on their ability to become resistant. Here are a couple examples of tetracycline resistant mycoplasma that have been found:

16S rRNA gene mutations associated with decreased susceptibility to tetracycline in Mycoplasma bovis.
https://www.ncbi.nlm.nih.gov/pubmed/25403668

Evidence for the predominance of a single tet(M) gene sequence type in tetracycline-resistant Ureaplasma parvum and Mycoplasma hominis isolates from Tunisian patients.
https://www.ncbi.nlm.nih.gov/pubmed/22580915

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[kristie]

Well I’ve been on the mino a few weeks. I’ve stopped herxing and I feel better than I have since the doxy stopped being as effective. I saw my dr yesterday and she agreed to trying the clarithromycin. She doesn’t know AP at all but she sees it’s been working so she left it up to me on how to dose. I have mino, doxy and clarithromycin but I can’t decide if I should make a change since the mino is working at the moment. Any input would be greatly appreciated! Really hope to hear your thoughts, Phil and Maz. Thank you, Kristie

[PhilC]

Hi Kristie,

I’m a big fan of using more than one antibiotic. Doing that reduces the chance of antibiotic resistance developing, and it hits the bacteria much harder. With the right combination of antibiotics, it’s also possible to eventually eliminate the infection completely and get off of the antibiotics. That’s much less likely to happen if a person is taking only one antibiotic.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[Maz]

While I’m also a fan of combo abx protocols in some scenarios, staging the introduction of different abx should probably be gauged in relation to patient response and type of bug. E.g. In early “acute” Lyme or in someone with good immune function, a high dose whack with doxy or penicillin is often enough, but in “chronic” Lyme, where the bug has become pleomorphic and capable of eluding the immune system by protecting itself in biofilm and reverting to dormant cyst form to resist abx, multiple antibiotics are usually necessary and often not optional (with other supports needed). Chlamydia pneumonia can be another chronic bug that is pleomorphic and requires combos for similar reasons. However, staging the introduction of other abx can also have a lot to do with patient response. Feeling better with just a few weeks of mino, when the worst of herxing seems to have passed, adding a second abx might be stirring the pot prematurely and/or unnecessarily.

So, if the triggering bug(s) are unknown and improvement is being experienced, it might just make sense to wait to about the 6-8 month point before deciding whether or not to add the secondary abx, after determining if there has been clear improvement in labs and signs/symptoms. Many people do very well on just minocycline for years (and decades). Some may choose or need to do a rotation to doxy or another abx in a different class for 6 months or so, around the 5 year mark, then go back to mino to alleviate or offset the chance of tolerance issues or to relieve things like skin hyperpigmentstion, if experienced.

So, there’s pros and cons to both choices. In any case, if the decision is ultimately made to add a second abx, it’s not a bad idea to wait for a bit to let herxing (which can come in rounds for months to come) to settle down. More herxing is a strong potential with a second abx and it can be tricky to decipher these symptoms from allergy, so staging introduction in a slow and measured way can help offset this potential and improve tolerability for the person.

Bottom line…it’s a personal choice when working with an inexperienced, but open doc, unless an experienced doc makes a recommendation, one way or another. Sorry not to be more definitive, but, (besides the fact that none of us are medical professionals capable of giving advice) patient experience has shown here, over the years, that each person is unique in response, so there really are no hard and fast rules when the infectious trigger(s) is an unknown.

[kristie]

Thank you Phil and Maz! Your advice is so appreciated! I have had non stop visits from family so I haven’t been able to get back on here and update.
My dr checked my ASO titre and it came back high so she prescribed me a course of penicillin at 600mg 3 times a day for 10 days. My pharmacist said it was ok with the mino but to space them an hour apart. Today is the first day I could get on here and I’ve been wearing out the search engine. Much to my dismay I came across info saying that mino makes penicillin less effective? I’m halfway through my penicillin and I doubt I will be getting more as my dr is really not that comfortable with AP as it is. Soooo should I just keep on with the mino 100mg bid and the penicillin as prescribed by a not into AP dr or is there a better way to dose? I really don’t want to waste my short course of penicillin…
I feel there is a strep component to my RA as my ASO titre was elevated but not dealt with when my RA began. Since starting the penicillin the only symptom change I’ve noticed is itchy skin but I don’t think it’s an allergic reaction…I think I need to detox better. Now that I have time I shall start my saunas again. Also since being back on the mino my aches and pains have subsided and I haven’t had any more herxing since that first week just over a month ago.
I was going to wait awhile as Maz suggested before I introduced the clarithromycin but now I’m wondering if I should start it on the heels of the penicillin in light of my elevated ASO? Unfortunately the dr left it up to me to figure out the dosing of the clarithromycin and mino combo…does anyone have a good schedule that worked for them that I could run by her? Thank you all for your insight! You all have helped pull me out of that dark depressing RA hell twice now and I just can’t express my gratitude enough! Thank you for your insight!!!
Kristie

[Maz]

kristie wrote:

Soooo should I just keep on with the mino 100mg bid and the penicillin as prescribed by a not into AP dr or is there a better way to dose? I really don’t want to waste my short course of penicillin

Hi Kristie,

Personally, although probably not harmful, I wouldn’t take penicillin along with minocycline, because the minocycline will reduce the effects of the penicillin. Would also be important not to do both together if treating for an acute infection in a high dose as you are doing. Pulsing in low dose, long-term setting (as Brown would have done) is a different matter. In that sort of instance, minocycline might be taken in the am and penicillin in the pm or alternate day pulsing, for instance.

Amoxicillin and clarithromycin make for more compatible abx partners, so your idea to combine it with penicillin isn’t a bad one….just wouldn’t do all three at once as wouldn’t want to negate any effects of the penicillin, especially when treating in an acute infection short course.

Drugs.com (amoxicillin/clarithromycin interaction checker)

I was going to wait awhile as Maz suggested before I introduced the clarithromycin but now I’m wondering if I should start it on the heels of the penicillin in light of my elevated ASO? Unfortunately the dr left it up to me to figure out the dosing of the clarithromycin and mino combo…does anyone have a good schedule that worked for them that I could run by her? Thank you all for your insight! You all have helped pull me out of that dark depressing RA hell twice now and I just can’t express my gratitude enough! Thank you for your insight!!!

Bearing in mind that none of us can suggest anything medical here and it’s all just speculative discussion to check with the doc, if it was me, I’d stop the mino, take a few days washout, then take both the amoxy and clarithromycin together for the full 10 days. After the penicillin was done, I’d carry on with the clarithromycin and, if herxing from the strep abx combo, I’d wait till that settled before adding the mino back in. Just what I’d probably do, but only after discussion with my doc. I know this is hard as you’re figuring this out with a non-AP doc, but it’s important to know that we can only offer fellow-patient insights and experiences, which really can’t take the place of medical advice, a just offering ideas to talk to the doc about.

It’s kind of important to know that if you aren’t dealing with an acute strep infection, it’s possible that a short-course won’t do much to bring your ASO down. Brown would treat on a long-term basis until that number was nudged right down to normal. You might find that the clarithromycin will help with that, but if not, you might want to go back to the drawing board again around the 6-8 month mark if you’re not experiencing improvements in labs/symptoms, Kristie.

[kristie]

Thank you so much Maz! I talked to my dr and she wasn’t keen on prescribing more penicillin so she switched out the mino for the clarithromycin for the last 5 days of my penicillin round. I’ve been taking 250 mg bid of clarithromycin based on the studies by M Ogrendik but split his daily dosage into B.I.D. I’m on my last day of penicillin and not sure what to do next. So far I haven’t had my typical herxing and when I switched doxy for the mino I felt it within 24 hours so not sure what to make of that. Although, I’ve been sooooo itchy so I figure it must be kicking something out!

Like you said Maz, not sure this blast of penicillin is going to do much to my ASO so I’d like to keep dosing the clarithromycin. However, since I do so well on mino I’m nervous to let it go. So if I were to do both and take the clarithromycin on t, th and sat do I still take the mino those days or swap it out? I noticed Dr. Brown did the ampicillin in the evening with the tetracycline in the am….I would really appreciate to hear what is working for others.

I certainly understand that we are patients sharing here and I run all this by my dr. In fact my dr has a laugh as I’m her only patient who comes in with a binder full of photocopied info and studies for her. Hopefully what she is learning will help others too!

Thank you, Kristie

[PhilC]

Hi Kristie,

If you take minocycline and clarithromycin then you’ll almost be on the Stratton Protocol.

See:
http://www.cpnhelp.org/treatment_protocols

Also see:
http://www.cpnhelp.org/wheldon

The Wheldon Protocol is similar, being based on the the Stratton Protocol.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[Author]

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