Clindamycin (brands: Cleocin, Dalacin, Clinacin) is a broad-spectrum antibiotic in the class of lincosamides, which is used as an anti-parasitic and to treat both aerobic gram-positive and anaerobic gram-negative bacteria by inhibiting protein synthesis in susceptible microbes and preventing their growth. It is used for infections of the bones and joints, lungs (pneumonia), middle-ear, throat (strep throat), skin (MRSA, cellulitis), blood (malaria, babesiosis), female reproductive organs, and internal organs. Clindamycin is available in oral, intramuscular and intravenous forms, and Dr. Brown used IV clindamycin mostly in severe and longstanding cases of rheumatoid arthritis as a means to clear organisms that may have taken up residence in the gut, respiratory tract and/or other parts of the body and provide for greater receptivity of oral therapy to follow. This antibiotic has been associated with a risk for clostridium difficile (C. Diff.), but is generally well-tolerated when adequate daily probiotics are administered concomitantly.

Note: For helpful recommendations on specific probiotic strains for the support and management of Clostridium difficile infection, click here and scroll to the Conclusions at the foot of this article.

Randomised Double-Blind Trial of Combination Antibiotic Therapy in Rheumatoid Arthritis. Int J Rheumatol. 2011;2011:585497.

A 25-week, double-blind, placebo-controlled, randomized trial of 20 patients with active rheumatoid arthritis (RA) was conducted at the Kennedy Institute of Rheumatology, Charing Cross Hospital, in London, to study the efficacy of a combination antibiotic approach to treatment. This trial followed an early pilot trial carried out at the same London hospital in 2006 (see study directly below) that concluded promising results.  Two-thirds of the study participants received active treatment, consisting of oral tetracycline (250mg twice daily, 3 days per week) and intravenous (IV) clindamycin, twice daily, initially for 5 consecutive days in graduated amounts up to 900mg, followed by weekly IVs (900mg) for 3 weeks, and bi-weekly IVs for the remainder of the 6 month study (totally 18 clindamycin infusions per patient). The results of this study were not consistent with the earlier pilot study with only 2 out of 12 treated patients achieving an American College of Rheumatology treatment response (ACR20) of 20% in disease parameters. Although it was intended to study 50 patients with active RA, the study was halted as the researchers deemed it unlikely that a further 30 patients would benefit from treatment. As a result, the authors concluded that this combination antibiotic treatment was not likely to be a valuable treatment for active RA.

RBF Commentary: This study was conducted, based upon beneficial clinical responses noted by a British general practitioner, Dr. Graham Hornett (now retired), who had successfully treated RA patients with Dr. Thomas McPherson Brown’s antibiotic protocols. It should be noted that this prematurely-aborted study bore inherent flaws. First, this trial was only intended to run for 6 months, whereas the pilot study was conducted over the course of 1 year. Antibiotic therapy is a slow-therapy and notable improvements in signs and symptoms are not expected to any great extent within this short time frame. Second, it is unusual for RA patients with active, more entrenched disease of longer duration to reap much benefit in the shorter term and these patients may indeed experience significant worsening for the first few months of therapy. Third, as with the first trial, the researchers used the first generation tetracycline, which tends to take longer for improvements to occur than the second generation oral antibiotic, minocycline (or doxycycline) and has been shown in the Minocycline in Rheumatoid Arthritis trial to yield significant, measurable treatment benefit and, subsequently, was approved by the American College of Rheumatology (ACR) as a disease-modifying anti-rheumatic drug (DMARD). Fourth, patient experiences reported to this foundation have evidenced that a greater proportion of RA sufferers improve with the use of IV clindamycin in addition to oral minocycline. Fifth, oral minocycline generally needs to be titrated to patient tolerance, as the paradoxical early worsening (a Jarisch-Herxheimer response) that is often experienced soon after commencing treatment is relative to pre-existing levels of inflammation. It is unfortunate that these researchers, although acknowledging their study’s limitations and stating an awareness of Dr. Brown’s 5-decade-long tenure as a rheumatologist who had much success in individualizing antibiotic protocols (AP) for his RA patients, were unfamiliar with the mechanistic approach to this treatment and its rationale for use.

Single-blind randomized trial of combination antibiotic therapy in rheumatoid arthritis. J Rheumatol. 2006 Feb;33(2):224-7.

In a 12-month, placebo-controlled, single-blind, randomized pilot study of 21 patients with active rheumatoid arthritis (RA), previously treated, but unresponsive to conventional medications, researchers at the Kennedy Institute of Rheumatology, Charing Cross Hospital, in London, aimed to evaluate the clinical efficacy of combination antibiotic therapy. In the treatment group (11 patients), patients were administered oral tetracycline (250mg twice daily, 3 days per week) and intravenous (IV) clindamycin, twice daily, initially for 5 consecutive days in graduated amounts up to 900mg, followed by weekly IVs (900mg) for 3 weeks, and bi-weekly IVs for the remaining 11 months. These researchers concluded that a combination of oral tetracycline and IV clindamycin may be useful in RA disease management, as 8 patients in the treated group had a 20% improvement in tender joint count (and only 1 placebo patient) and 5 of these had achieved improvements by American College of Rheumatology (ACR20) response criteria.

RBF Commentary: Had oral minocycline been used in this study, outcomes may have been substantially superior. In spite of this, this is the first study of a combination antibiotic treatment for RA that closely resembles the low, pulsed oral tetracycline and IV clindamycin combination antibiotic protocols of Dr. Thomas McPherson Brown, particularly in the early days of his tenure and prior to his preferred use of the second generation tetracyclines, minocycline and doxycycline. It is noteworthy that although research variables need to be minimized with patient cohorts receiving the same dose, Dr. Brown titrated antibiotic therapy to patient tolerance in an individualized approach. He also recommended starting antibiotic therapy as early as possible, upon diagnosis, and anecdotal patient experiences shared with this foundation have confirmed his findings that early RA tends to respond more swiftly to this treatment than cases of long-standing, entrenched disease where more time is often needed to experience marked improvements.

Rat bite fever mimicking rheumatoid arthritis. Scand J Infect Dis. 2005;37(6-7):532-3.

A case study describing a patient, a pet shop employee, who experienced polyarthritis that mimicked rheumatoid arthritis due to the infection, Streptobacillus moniliformis, know to cause “rat bite fever.” Rat bite fever, found world-wide and caused by two types of bacteria, is an example of an a rodent-transmitted infection, usually by via a rodent’s mucous or urinary secretions, that can result in numerous symptoms, including rash, fever, chills, muscle aches, and painful swollen joints and back. In this case, the patient recovered well after surgical debridement of the affected joints and a 4-week combination of the antibiotics, rifampin and clindamycin.

Penetration of lincomycin (‘Lincocin’) and clindamycin (‘Dalacin’) into the synovial cavity in rheumatoid arthritis. Curr Med Res Opin. 1972;1(2):108-15.

In a study of 18 rheumatoid arthritis patients, treated with either lincomycin or clindamycin, minimal inhibitory synovial fluid concentration of the antibiotics were achieved within one hour.


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