Why is the AP pulsed?

[Hoping]

Dr. Brown instructed that the use of antibiotics in AP should be pulsed. From the posts, it seems that quite some docs prescribe daily dosages. I went back to re-read parts of the “Road Back” book. I couldn't find his explanation for pulsing. Did I miss it somewhere?

[Maz]

[user=1182]Hoping[/user] wrote:

Dr. Brown instructed that the use of antibiotics in AP should be pulsed. From the posts, it seems that quite some docs prescribe daily dosages. I went back to re-read parts of the “Road Back” book. I couldn't find his explanation for pulsing. Did I miss it somewhere?

Hi Hoping,

Here is a link on the main site under the Historical Protocol describing Dr Brown's rationale for pulsed or “intermittant” dosing:

https://www.roadback.org/index.cfm?fuseaction=studies.display&display_id=184#Anchor-The-14210

toc)

The treatment approach in the microbial hyper-sensitivity state is determined to be altogether different from standard anti-microbial therapy. In rheumatoid disease, the hyperreactive state itself suppresses microbial antigen replication and accounts for the high degree of localization of mycoplasma foci of involvement. The primary objective of treatment is the suppression of antigen production and at the same time avoiding the sudden release of excess antigen and delayed drug sensitivity by over medication.

Effective treatment has evolved to be the converse of the treatment of standard infection. The dosage of medication is relatively low instead of high, it is generally interrupted instead of sustained, and the treatment is usually long-term.

In all microbial hypersensitivity states, the causative agent virtually goes underground as the tissue reactivity becomes manifest. Thus, in the highly reactive state, very little anti-microbial medication is needed to further control the disease. And if too much is given, the body begins to react against the medicine itself and defeats the purpose of the treatment. This is the main reason for the intermittent treatment. All bacterial hypersensitivity states require intermittent antigen suppressing treatment as exemplified by tuberculosis, rheumatic fever and brucellosis.

toc)

The fundamental treatment goal in the induction of a sustained remission is to control and suppress antigen production. The final objective has been the ultimate elimination of the microbial antecedent.

In the primary objective, the suppression of antigen production, dosage needs to be tailored to the individual patient to avoid the sudden release of excess antigen and delayed drug sensitivity by over-medication. The degree of anti-mycoplasmal medication may need to be reduced to the minimum, such as minocycline, 50 mg. once or twice a week, gradually increasing according to patient tolerance in these individuals.

An important guideline in successful treatment has been the avoidance of over-medication with paradoxical worsening. Too much medication can cause a delayed hypersensitive reaction to the drug itself and induce a flare of the arthritis with the development of symptoms closely mimicking the disease (Herxheimer Reaction). A therapeutic balance can be readily reestablished by the temporary interruption of the treatment for a week and then restarting at the same low dose.”

Hope this helps? Essentially, pulsed, intermittant dosing is normally prescribed for those patients who have an inflammatory component to their disease or have mild disease.

Peace, Maz

PS The Dr Brown video also provides pretty good coverage of this topic, particularly at the end when dosages are described in some detail:

http://www.vimeo.com/3154687

If the video stutters, just hit pause, allow the gray buffer line to get to the end, then press play again. Should run smoothly then. 😉

 

[Hoping]

Thanks, Maz, for the detailed reply. I watched the Dr. Brown video a while back. I'll re-visit it a little later and pay attention to the details. Just curious, who wrote the Roadback educational info? I went back to the “New Arthritis Breakthrough” and checked again. Henry Scammell did explain that it's hypersensitivity. Before I posted, I was looking at only the part written by Dr. Brown himself and saw his instructions for the physicians but didn't see his explanation. Thanks again.

[Maz]

[user=1182]Hoping[/user] wrote:

Just curious, who wrote the Roadback educational info?

 

Good question, Hoping. 🙂 Cheryl F can correct me here, but if memory serves, the educational info was put together originally by Pat Ganger and Ethel Snooks and overseen/approved by Henry Scammell and Dr Coker-Vann, the latter two of whom worked very closely with Dr Brown…Scammell having written the books for Brown and Dr Coker-Vann having worked as Brown's associate in the lab at TARCI.

Peace, Maz

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