Dr. Thomas McPherson Brown Antibiotic Treatment Plan FAQ

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TREATMENT OF INFLAMMATORY RHEUMATIC DISEASE WITH LOW DOSE ANTIBIOTIC

THERAPY: RHEUMATOID ARTHRITIS, SCLERODERMA, LUPUS, POLYMYOSITIS,

DERMATOMYOSITIS,

PSORIATIC ARTHRITIS, ANKYLOSING SPONDYLITIS, REITER'S SYNDROME AND JUVENILE

RHEUMATOID ARTHRITIS

_http://rheumatic.org/index.html_ (http://rheumatic.org/index.html)

 

FREQUENTLY ASKED QUESTIONS ABOUT ANTIBIOTIC THERAPY

_http://rheumatic.org/faq.htm_ (http://rheumatic.org/faq.htm)

 

1. HOW DOES ANTIBIOTIC THERAPY DIFFER FROM CONVENTIONAL THERAPY?

 

Antibiotic therapy is based on the theory that inflammatory rheumatic

diseases such as rheumatoid arthritis, scleroderma, lupus, juvenile rheumatoid

arthritis, polymyositis, ankylosing spondylitis, etc. have an infectious cause

such as mycoplasma and other bacterial L forms. Significant evidence supporting

this theory has been published in medical literature for decades. The use of

low dose antibiotics, particularly from the tetracycline or macrolide

families, attack the disease process at its source, namely the infectious

agent. In

contrast to the treatment of ordinary, acute bacterial infections with

faster growing bacteria, the bacterial forms which trigger the chronic

infectious

disease processes are much slower growing organisms; thus, the antibiotic

protocols prescribed for treating the rheumatoid diseases are based on the use

of long-term, low-dose antibiotics, usually given only three days per week -

sometimes more frequently.

 

This therapy is equally effective in patients with severe and/or

long-standing disease as it is in those with mild to moderate disease. Thomas

McPherson

Brown, M.D. (1906-1989), a well known rheumatologist who practiced in the

Washington, D.C. area, pioneered this treatment over fifty years ago and

successfully used it to treat over ten thousand patients during his lifetime.

 

In contrast, however, the toxic medications used by rheumatologists today in

conventional therapy are prescribed to try and control or suppress symptoms

rather than to eradicate the underlying bacterial infection, which is the

root cause of the disease process. These more toxic drugs may or may not be

effective. If they do work, it is only a matter of time before they either lose

their effectiveness or the patient develops side effects, forcing him/her to

discontinue usage of them. The patients often are left worse than before they

ever started the medication.

 

The ultimate decision about whether this antibiotic therapy is appropriate

for you should be made with advice from your physician. Treatment must be

tailored to the individual patient. While this therapy is effective for the

vast

majority of rheumatoid patients, it does not always work for everyone. If

treatment failure occurs, then other misdiagnosed medical problems must be

investigated carefully, always keeping in mind that one can have more than one

disease process as well as more than one diagnosis going on in one*s body at the

same time.

 

For example, toxic root canal teeth and Lyme Disease (caused by a

spirochete) are two of the most commonly overlooked problems which can lead to

treatment failure because they require separate treatment programs. In fact, if

either of these two diagnoses is so much as suspected of being even a remote

possibility, then appropriate testing should be done before starting any long

term

antibiotic protocol in order to prevent unnecessary complications with this

therapy. [Lyme Disease is now associated with over 300 medical conditions

including ALS; Alzheimer's disease; Parkinson's disease; MS; almost any

inflammatory or degenerative central, autonomic, and peripheral neurological

disturbance; fibromyalgia; IBS; eye inflammation; rheumatoid arthritis;

scleroderma;

lupus, etc. Patients need to be aware that current guidelines for testing

Lyme often result in false negatives. Researcher Joanne Whitaker, M.D. has

developed a more accurate test for Lyme Disease called the Q-RIBb test which

actually looks for the cell wall deficient form of Borrelia Burgdorferi, rather

than relying on detection of antibodies. This test is available from Central

Florida Research, Inc. They accept billing for Medicare and most major

insurance companies. Check their website for more information.

_www.centralfloridaresearch.com_ (http://www.centralfloridaresearch.com) . The

phone number is

863-956-3538.]

 

2. WHAT ANTIBIOTICS ARE USED AND WHAT IS THE DOSAGE?

 

Typically, patients with severe and/or long-standing disease are started

with a series of daily intravenous clindamycin for five to seven days. (See

Section 11.) The first two days, 300 mg. of clindamycin would be administered

in

250 cc 0.9% saline dripped over a 50 to 60 minute period. (D5W is not used

because of the yeast overgrowth found in a large percentage of these patients.)

The third and fourth day 600 mg. is given, the fifth and subsequent days 900

mg. Some physicians build up to 1200 mg.

 

After the initial daily intravenous series, IVs may be administered once

weekly, once every other week or as the physician determines for the individual

patient. The IVs are continued until all lab figures return to normal, which

can often take longer than a year, sometimes several years for patients with

severe and/or long-standing disease. Lab results should then be monitored for

several months longer, to be sure that the patient remains stable, before

discontinuing the IVs.

 

Various modifications to the late Dr. Brown*s original antibiotic protocol

regarding the use of IV clindamycin have been made by some physicians

currently treating rheumatoid patients today. Some physicians have reported

success

using clindamycin orally, or in intramuscular injections. Orally, the single

dose is 1200 mg. once a week. For intramuscular injections, 300 mg to 600 mg.

once a week. For sensitive patients, a local anesthetic may be applied to the

injection site. However, simply changing the needle tip, after drawing the

medication into the syringe and before injecting it, will avoid the problem of

tissue irritation at the injection site, because it is the trace amount of

medication on the tip of the needle that causes the tissue irritation.

 

[A. Robert Franco, M.D., a rheumatologist in Riverside, California who has

years of experience in using this therapy, often prescribes a seven day series

of IV clindamycin every five weeks for four cycles and then reassesses the

patient*s needs. In some of his patients. Dr. Franco has substituted oral

Zithromax (azithromycin) 250 mg. twice daily for two days each week (Tues. &

Thurs.) in combination with oral Minocin (Mon., Wed., & Fri.).] When the

initial

course of IVs is completed, patients begin oral therapy - minocycline

(Minocin) or doxycycline (Vibramycin/Doryx) 100 mg. once or twice daily, or

tetracycline 250 mg. to 500 mg. twice daily Monday, Wednesday and Friday. This

intermittent therapy (also referred to as pulsing) is effective for most

patients.

More is not necessarily better; however, in some cases, five or even

seven-day a week doses may be necessary for a limited time. The use of higher

doses

tends to make it more difficult to keep the intestinal tract in balance.

Patients with mild to moderate disease are started with this same oral therapy,

but often without the initial week-long series of IV clindamycin at the

beginning. Erythromycin can be substituted for those patients sensitive to the

tetracyclines.

 

Tetracycline is more apt to react with food and must be taken on an empty

stomach. Some patients may need to take doxycycline with food, especially at

first until their body gets used to it, although doxycycline is better absorbed

apart from meals. Taking 3 or 4 ounces of a pharmaceutical grade aloe vera

liquid shortly after taking the antibiotic has been found beneficial for those

with sensitive stomachs. Reliable brands of aloe vera would include: Coats

International, Garland, TX - _www.coatsaloe.com_ (http://www.coatsaloe.com) Ð

1-800-486-ALOE - liquid Allied Pharmacy - Arlington, TX - 1-800-428-6331

(organic aloe) - capsules

 

None of the antibiotics in the tetracycline family (tetracycline,

doxycycline, minocycline) should be taken at the same time with calcium

supplements,

including dairy products, or with any other minerals such as magnesium, iron,

etc. which have the same chemical valance as calcium. Ask your pharmacist for

advice here because it is known that other minerals can also have similar

inhibiting effects as calcium does on the absorption out of the GI tract of all

antibiotics in the tetracycline family.

 

Caution: Be sure to drink a full glass of water and to remain sitting

upright for at least 30-45 minutes whenever taking any antibiotic in the

tetracycline family in order to prevent esophageal injury. For this reason, do

not take

this medication immediately before going to bed at night, but remain sitting

up long enough to be sure the pill reaches the stomach and does not remain

stuck in the esophagus, where it might dissolve and cause painful esophageal

burning and scarring.

 

Some reported sensitivities to the tetracycline drugs may be caused by the

drug being introduced too rapidly and at too high a dose. A slow start, 50 mg.

Monday and Friday then gradually building up to the standard dose (100 mg.

once or twice Monday, Wednesday and Friday), can often avoid this allergic

reaction.

 

Caution: Some oral generic tetracyclines have been found to be ineffective

for this therapy.

 

For children under twelve with inflammatory rheumatic disease, EryPed

(erythromycin), is prescribed in place of the tetracycline drugs, to avoid

staining

of teeth. The dosage is one teaspoon (200 mg.) three times a day for 15 to

21 days; then 200 mg. two times a day thereafter, seven days a week - taken

with food. The patient is kept on this medication for three to six months after

labs return to normal. If labs are still normal after this time, tapering of

the drug may begin.

 

Caution: Erythromycin and clindamycin should not be taken together,

according to the Nursing Drug Handbook, because erythromycin may block access

of

clindamycin to its site of action.

 

Caution: Patients should always inform their physician of adverse reactions

to any of their medications.

 

Exacerbation of systemic lupus erythematosis has been reported in patients

taking minocycline, as has transient lupus-like symptoms. However, while some

physicians report they have not had a problem at the low doses used in this

protocol, other physicians avoid the risk by prescribing erythromycin for

their lupus patients - 333 mg. twice a day Monday, Wednesday and Friday - taken

with food. For those patients with sensitive stomachs, Ery-Tabs may be

prescribed. [As mentioned previously, taking three or four ounces of a

pharmaceutical grade aloe vera shortly after taking the antibiotic, has been

found

beneficial for those with sensitive stomachs. ]

 

Note: A suspected *causal* association between mycoplasma hominus and lupus

was shown in Cassell GH, Clough W, Septic Arthritis and Bacteremia Due to

Mycoplasma Resistant to Antimicrobial Therapy in a Patient with Systemic Lupus

Erythematosus, Clin Infec Dis, 1992; 15:402-407, and mycoplasma hominus is

known to be resistant to erythromycin, therefore necessitating the use of an

antibiotic in the tetracycline family, with Minocin being the most effective.

What might be happening, instead, is that the so-called *lupus flare* is really

another example of a Herxheimer reaction which is occurring. Therefore,

possibly by reducing the dosage and/or frequency of Minocin, and by monitoring

the situation closely with frequent, repeated lab testing, these precautionary

measures might be sufficient to resolve this potential problem concerning the

use of Minocin in treating lupus patients, before the situation can get too

far out of control.

 

ANTI-INFLAMMATORIES: Reducing the inflammatory barrier is essential to allow

penetration of the antibiotic. NSAIDS as well as aspirin preparations

(preferably enteric coated) are used for this purpose. These drugs and the

dosage

will need to be tailored to the individual. All of them must be used with

caution as they can cause serious side effects. (_www.rxlist.com_

(http://www.rxlist.com) ) Other products known to reduce inflammation and safer

than NSAIDS

include:

 

1. & 2. Cod liver oil (Kirkland's or Carlson*s - both mercury free) -

suggested dosage is 1 TB twice a day with 400 IU of vitamin E.

3. Wobenzyme-N- two tablets [ multi systemic enzymes preperation] on an

empty stomach three times a day to start - increasing to five tablets three

times

per day. The anti-inflammatory action is lost if there is food in the

stomach.

 

In highly sensitized individuals, antihistamines and small doses of

corticosteroids (less than 5 mg. a day) are helpful. **To reduce the

inflammatory

barrier and allow penetration of the antibiotics, 1 to 5 mg of prednisone may

be

administered to the patient simultaneously with the antibiotic. Preferably

no more than 10 mg. should be administered for flares. Larger doses when

required should be given in short interrupted courses. It is of interest that

the

concomitant use of antibiotics with the steroids makes steroid withdrawal

easier. The dosage of the drug must be kept low to avoid interfering with the

immune system but high enough to reduce the hypersensitivity or allergic

inflammatory reactions of the disease.** Dr. Thomas McPherson Brown in

Antibiotic

Treatment Plan.

 

INJECTING THE JOINT

Thomas McPherson Brown, M.D. et al in Antimycoplasma Approach to the

Mechanism and the Control of Rheumatoid Disease from Inflammatory Diseases and

Copper, The Humana Press 1982 states: **Intraarticular injections of

clindamycin

have been very effective when the reactive state of the joint is so intense

that penetrance (of the antibiotic) is not achieved by the oral or IV route.

The inflammation must be reduced in most instances for maximum clindamycin

effect. The usual treatment plan for large joints, clindamycin 300 mg, plus

dexamethasone 4 mg. A reduced amount of the same combination of these

medications

is used for smaller joints.**

 

3. IS THERE AN ADVANTAGE TO USING MINOCYCLINE (MINOCIN) OVER THE OTHER

ANTIBIOTICS?

 

Yes, bacterial cell membranes are surrounded by a lipid layer (a water

insoluble, fatty substance which surrounds the cell and provides it with fuel.

As

a means of resisting antibiotics, the cells increase the thickness of this

lipid layer. Minocycline appears to have greater penetrating ability. It also

has an extended spectrum of activity and stays in the system longer and at

higher levels than tetracycline. HOWEVER, there are patients who have had

excellent response using doxycycline and tetracycline.

 

4. ARE THERE ANY SIDE EFFECTS FROM USING ANTIBIOTICS?

 

The tetracycline antibiotics taken in low dose, intermittent fashion, can be

used indefinitely without the build-up of tolerance to the drug and without

the serious side effects of conventional drugs. However, as with all

medications, side effects may be encountered. There have been some reports of

dizziness when starting the Minocin that may be due to starting at too high a

dose.

This usually abates with time; however, it should be reported to your

physician. Temporarily reducing the dosage of the Minocin may eliminate the

dizziness.

 

The antibiotics can cause yeast infections, as do NSAIDS, steroids,

methotrexate and the other drugs prescribed for these diseases. These drugs

kill off

the necessary good bacteria in the intestinal tract. Before starting this

therapy, patients should be tested for candida immune-complexes, and if found,

appropriate treatment should be prescribed. Conventional therapy would include

anti-fungals such as Nystatin or Diflucan. Natural therapies would include

diet, olive leaf extract along with slippery elm, L glutamine, and grapefruit

seed extract. [see Section 13 for list of laboratories testing for candida

immune-complexes.]

 

Reliable brands of olive leaf extract would include:

 

Seagate Products - _www.seagateproducts.com_ (http://www.seagateproducts.com)

- 1-888-505-4283 East Park Research - _www.lef.org_ (http://www.lef.org)

(distributor) - 1-800-544-4440

 

It is extremely important that patients take a good probiotic while on this

therapy in sufficient quantity to replace the good bacteria destroyed by

these drugs. Effective products include - Natren*s Healthy Trinity -

_www.natren.com_ (http://www.natren.com) or 1-866-462-8736 Metagenics Ultra

Flora Plus -

NEEDS - 1-800-634-1380 Culturelle by Klaire - _www.needs.com_

(http://www.needs.com) Grainfields (_www.grainfields.ca_

(http://www.grainfields.ca) or

_www.agmfoods.com_ (http://www.agmfoods.com) )

 

Diarrhea is listed as a side effect, especially with the clindamycin, but

this has not been encountered at the dosage used in this therapy. Some

patients* stomachs have become sensitized from medications prior to starting

this

therapy and may experience nausea. Taking the drug with food (no dairy

products)

may help. It has also been found helpful to start with a reduced dosage - 50

mg. once or twice a week for up to several months, gradually increasing to

the recommended dose. Taking three or four ounces of a pharmaceutical grade

aloe vera shortly after taking the antibiotic may be helpful for the nausea.

 

It is recommended that patients avoid direct sunlight while on these

antibiotics.

 

5. WHAT IS HYPERPIGMENTATION?

 

Minocycline can cause discoloration of the skin anywhere on the body. This

is called hyperpigmentation. Large daily doses of ascorbic acid (vitamin C)

may prevent this phenomenon. (Bowles WH, Baylor College of Dentistry, Texas A & M

University System Protection against minocycline pigment formation by

ascorbic acid, J Esthet Dent, 10(4):182-6 1998)

 

Dr. A. Robert Franco, a rheumatologist practicing in Riverside, California,

says that hyperpigmentation occurs in about 10% to 20% of patients taking

minocycline (Minocin) on a daily basis and over one year. Occasionally it may

appear earlier. It occurs less frequently with patients taking Minocin on a

three times per week basis. It may be necessary to switch to another

antibiotic.

It is usually reversible after discontinuation of the medication, but fades

slowly and sometimes not completely.

 

Dr. Pnina Langevitz in Israel has done three double-blind studies on the use

of minocycline in rheumatoid arthritis with some patients on the medication

over 5 years. The following is from Langevitz et al - Minocycline in

Rheumatoid Arthritis; Isr. J. Med Sci 1996;32:327-330. **We also observed skin

hyperpigmentation in about one third of our patients as a late complication of

the

therapy. Minocycline related hyperpigmentation of the skin is a well known

complication of this agent and can be subdivided into three categories. The

first is characterized by dark black-blue macules localized at sites of

cutaneous inflammation. . . . . . . . . . . The second type is a more diffuse

hyperpigmentation, predominantly on the lower extremeties and on areas exposed

to

sunlight. . . . . . . . The third form of minocycline-induced hyperpigmentation

is the *muddy skin syndrome* Ð a dark brown-gray discoloration of the skin

generalized over the body, less prominent in non exposed areas. The high

incidence of skin hyperpigmentation in our group of patients is probably due to

the longer follow-up period than that in other groups, and to sun exposure.**

(Patients in this study were on 100 mg. of minocycline twice daily.)

 

6. WHAT CAN I EXPECT WHEN STARTING ANTIBIOTICS?

 

The return to health will normally be a slow, subtle process. In many cases,

when treatment begins, the patient will temporarily experience a worsening

of symptoms that can also cause a temporary increase in laboratory values.

This is called the Jarisch-Herxheimer reaction. (See Section 7.) Flares will

occur during the course of therapy, but over time, these flares will decrease

in

intensity and be spaced further apart until the infectious agent has been

weakened to the point where the patient*s immune system can take control.

Patients have reported improvement of their symptoms, including depression,

fatigue, memory, stiff and painful joints, muscle tone and strength, range of

motion, dry, cracked or tight skin, bursitis, tendonitis, vaculitis due to

inflammation, skin ulcers, swallowing difficulties and heartburn. Patients with

Raynaud*s symptoms have also experienced improvement.

 

The return to health will normally be a slow, subtle process. In most cases,

when treatment begins, the patient will experience a temporary worsening of

symptoms. This is called a Jarisch Herxheimer reaction. (See Section 7.)

Laboratory results may also worsen temporarily. Flares will occur.

 

7. EXPLAIN THE JARISCH HERXHEIMER REACTION.

 

This drug-induced flare reaction may occur within hours, the next day or

within the first weeks after the patient starts the antibiotics - or any time

there is a change in antibiotic or dosage. It is caused by a die-off of

organisms, which in turn create toxins that circulate in the body. This will

often

cause a temporary worsening of symptoms. Patients may experience a range of

symptoms from mild fatigue and sleepiness to flu-like symptoms - chills, low

grade fever, night sweats, muscle aches, aching and swollen joints, nausea,

hives, skin rashes, depression and short term memory loss. Hives and rash are

sometimes mistaken for an allergic reaction.

 

If the Herxheimer reaction is severe, the medication may be stopped and a

small dose of prednisone (no more than 10 mg.) may be prescribed. When the

flare subsides, the medication is re-introduced at a slow rate.

 

When this Herxheimer reaction occurs, it is a good indicator that the

antibiotic is reaching its target - a very positive sign. The length of time

for

this reaction varies from patient to patient. About twenty percent of patients

do not experience the Herxheimer reaction. Scleroderma patients seem to

experience the Herxheimer reaction less often than RA patients.

 

Oxidative therapy may be useful in reducing these symptoms. Garth Nicholson,

M.D., director of The Institute for Molecular Medicine in Huntington Beach,

California recommends peroxide baths (four 16 oz. bottles of 3% hydrogen

peroxide in 20 inch bath or Jacuzzi, with 2 cups of Epsom salt. Patients soak

in

hot water plus the Epsom salt for five minutes until pores are open, then add

the peroxide solution. This should be repeated three times a week at

bedtime. No vitamins should be taken 8 hours before bath. The peroxide can also

be

directly applied to the skin after a hot shower/tub. The peroxide should be

left on for 5 minutes and then washed off.

 

Another useful suggestion from Dr. Nicholson - blend one whole lemon, then

add 1 cup fruit juice or water and 1 tablespoon of olive oil. Strain and drink

liquid.

 

Far-infrared saunas have also been found helpful in removing toxins from the

body. Instructions for building an inexpensive far-infrared sauna can be

found at _www.mercola.com_ (http://www.mercola.com) or _www.drlwilson.com_

(http://www.drlwilson.com) .

 

It is very important to drink adequate amounts of water to flush the toxins

from the body - no less than two quarts a day. Water not only flushes the

toxins out of the system, but lubricates the joints and carries nutrients to

the

cells. You also need to make sure you have two to three good size bowel

movements daily. Should constipation be a problem, try taking a rounded

teaspoon

of pysillium (Metamucil or a generic) in 8 ounces of water, one to three

times daily. Drinking warm prune juice on first arising in the morning is also

helpful. If necessary, you may also add powdered vitamin C (to tolerance) to

the prune juice.

 

Note: Scleroderma patients may have intestinal problems that involve lack of

motility in the colon. If they need a fiber supplement for stool

irregularities, they might do better with a product like Citrucel

(methylcellulose).

They should avoid products with the active ingredient pysillium.

 

8. IS DIET IMPORTANT?

 

What you eat and how well your body metabolizes that food is very important

in keeping the immune system strong to fight disease. Basically, you need to

increase vegetable intake such as broccoli, cabbage, beets, spinach, celery,

cauliflower, brussel sprouts, carrots, swiss chard, kale, romaine lettuce,

etc. -50% raw and preferably organic. Avoid fast foods, fried foods, sugar in

all forms, soda pop (diet or regular), prepackaged foods, preservatives,

artificial ingredients, white flour, white rice, etc.

 

Suggested reading on nutrition is listed at the end of this article.

 

Chronic disease patients (as well as the elderly) are usually found to be

low in digestive enzymes and hydrochloric acid - both necessary for proper

digestion of food. Supplementation is recommended along with a good

multi-vitamin/mineral and essential fatty acids.

 

9. HOW LONG DOES IT TAKE BEFORE I START SEEING IMPROVEMENT?

 

The length of time a patient has had the disease and the strength of their

immune system will determine the recovery time frame. Some patients see

significant benefits in months, but for others it may take several years. Dr.

Pnina

Langevitz of Israel reported that the longer patients stayed on the

antibiotics the greater improvement they experienced. Patients can safely

remain on

these antibiotics for years without building up resistance to them.

 

Enhancing the immune system through diet and supplements, drinking

sufficient filtered water and proper daily elimination is vitally important not

only

to the process of achieving remission but also to maintain a remission.

 

10. CAN I EXPECT TO BE ABLE TO DISCONTINUE MEDICATION EVENTUALLY?

 

Some patients may find this treatment provides a permanent remission and no

further medication is needed, but most will need to stay on a maintenance

dose to keep the disease under control. If symptoms should return at any time a

short course of 100 mg. of minocycline or doxycycline, or 500 mg to 1,000 mg.

of tetracycline three times a day for three days will usually re-establish

the remission for an indefinite period. For some patients a return to normal

lab figures occurs before they reach a symptom free remission. For others the

reverse is true - the symptoms leave first and then the lab figures return to

normal.

 

11. WHY ARE THE IVs NECESSARY IN SEVERE OR LONG STANDING DISEASE?

 

In severe or long standing disease, or in very resistant cases, the oral

route may be inadequate for the antibiotic to reach its target and suppress

antigen formation. The intravenous clindamycin would then be required. The IV

clindamycin jump-starts the therapy, eradicating long-standing microorganisms

in

the gut, respiratory tract and other areas, creating greater receptivity for

the tetracycline drug.

 

IV clindamycin therapy is recommended in the treatment of all scleroderma

patients from mild to severe. When lab figures return to normal, these patients

may still require occasional IVs or a weekly dose of oral clindamycin to

remain stable.

 

12. WHAT LAB TESTS SHOULD BE DONE TO MONITOR MY PROGRESS?

 

Laboratory tests are done to help in the diagnosis of the disease and to

provide a baseline from which to measure progress after antibiotic therapy has

begun. These include a complete blood count (CBC), rheumatoid factor (RF),

erythrocyte sedimentation rate (ESR), C reactive protein (CRP), antinuclear

antibody (ANA), antistreptolysin-O titer (ASO), and mycoplasma complement

fixation (MCF). These tests can be repeated at your doctorÕs discretion to

follow

your progress.

 

Testing for strep before starting this therapy is extremely important.

According to Dr. Brown and others, running the ASO titer can produce a **false

negative.** In such cases, either the Anti-DNAse B (strep) test, also called

the

**ADB** test, and/or the Streptozyme test would be better. All strep tests

can yield false negative results, so the combination of both the ADB and the

Streptozyme test may be necessary in certain patients. The reason for this is

that the ASO test measures just one streptococcal enzyme, whereas the other

strep tests measure several different streptococcal enzymes, thereby increasing

the chances of detecting patients who are **carriers** of strep. When active

streptococcus is present, even at low levels, it must be treated.

 

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.

 

13. I HAVE BEEN ON 100 MG. OF MINOCYCLINE MONDAY, WEDNESDAY AND FRIDAY FOR

SIX MONTHS AND HAVE SEEN NO RESPONSE. CAN I STILL EXPECT IMPROVEMENT?

 

Yes, however you should have some indication by this time that the

antibiotic is working for you. Your doctor needs to do a little detective work

at this

point. Here are some things to check:

 

a. Laboratory tests should be run again. Often improvement in these tests

will precede improvement of symptoms.

 

b. If you are on a generic minocycline, change manufacturers or switch to

the brand name. Patients have discovered that not all generic minocycline or

doxycycline is equivalent. Many physicians prescribe the brand name to avoid

this risk.

 

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.)

 

d. Try one antibiotic in the morning and a different one at night, or

sequence them taking one for six weeks and then switching to another for six

weeks.

 

e. If your disease is severe, long standing or very resistant, and you are

only on oral antibiotics, you will need to add intravenous therapy.

 

f. Look for other sources of infection in the sinuses, allergies, root

canals (_www.altcorp.com_ (http://www.altcorp.com) ), intestinal tract, etc.

that

may be impeding your progress and must be addressed for optimum benefit from

this therapy. The first area to check is the intestinal tract for candida

overgrowth and leaky gut. There are special labs that perform these tests:

Immuno-Science Lab in Beverly Hills, CA - candida _www.immuno-sci-lab.com_

(http://www.immuno-sci-lab.com) or 1-800-950-4686 AAL Reference Laboratories,

Inc.

in Santa Ana, CA - candida _www.antibodyassay.com_

(http://www.antibodyassay.com) or 1-800-522-2611 Genova Diagnostics, Ashville,

NC - candida and the

lactulose mannitol test for leaky gut _www.gdx.net_ (http://www.gdx.net) -

1-800-522-47

 

g. Were you tested for strep? If the results were positive, treatment should

be prescribed. (See Section 12.) The strep organism can be very difficult to

eradicate, so even after the titer returns to normal, the patient should be

monitored for some time for recurrence. The goal of the therapy is to remove

antigen wherever it may be found in the body in order to achieve optimum

benefit from this therapy.

 

h. Are you deficient in antibody? Perhaps intravenous immunoglobulin is

necessary.

 

i. Did your doctor have the mycoplasma test run? It should be run for the

entire panel and not just for M. pneumoniae. The first test may be negative if

the immune system is too weak to mount an antibody attack to the organism.

Therefore, it is important to repeat the test within 3 to 6 months. If it is

still negative, the medication should be changed. The tetracycline antibiotic

still works in some instances of a negative reading. If the cause is viral the

antibiotic therapy may fail. Additionally, the cause could be streptococcus

infection compounded with a mycoplasma infection or vice versa. Laboratories

performing this special mycoplasma testing are listed on this web site in the

section titled **Information for You and Your Doctor**

_http://rheumatic.org/docs.htm_ (http://rheumatic.org/docs.htm) .

 

j. Are there hormonal imbalances that need correcting?

 

k. Chronic neurotoxins may be another reason for lack of response to this

therapy. These toxins are low molecular weight, fat soluble toxins, sequestered

in the adipose tissues of the body. Rather than being eliminated normally,

they are reabsorbed and continue to be accumulated and circulated in the body.

They impact the nervous system, the endocrine system and the immune system.

(Patients report improvement in brain fog and ability to concentrate when

these toxins are removed.) There is a vision test available on the net that can

be taken to determine if neurotoxins are present. For more information visit

Dr. Ritchie Shoemaker's site - _www.chronicneurotoxins.com_

(http://www.chronicneurotoxins.com) . Dr. Shoemaker has written a book on this

subject titled

**Desperation Medicine**. [Note: Not all neurotoxins respond to the therapy

developed by Dr. Shoemaker. Neurotoxins unresponsive to Dr. Shoemaker's

protocol may be helped by the protocol of Dr. Patricia Kane.

_www.detoxxbook.com_

(http://www.detoxxbook.com) or _www.bodybio.com_ (http://www.bodybio.com)

 

l. David E. Berg, director of Hemex Laboratories in Phoenix, AZ has

discovered that a number of infections, including mycoplasmas, can trigger the

blood

clotting system to become active, preventing oxygen and antibiotics from

reaching and destroying the pathogen. This is called hypercoagulation. The

Hemex

Lab ISAC panel can be run to determine if this is a problem. If this test is

positive, appropriate blood thinning agents may be prescribed. For more

information go to _www.hemes.com_ (http://www.hemes.com) or call

1-800-999-2568.

Check with your physician for non-prescription agents that may be

appropriate.

 

m. Consider testing for Lyme Disease which mimics so many rheumatic

diseases. Refer to Sections 1 and 18 for more information on Lyme Disease.

 

If a patient has been experiencing improvement on this therapy and then

notices that progress has stopped or he/she even seems to be regressing, the

information in this section will aid their doctor in determining what is

impeding

that progress.

 

 

14. MY DOCTOR HAS TOLD ME TO STOP THE MINOCYCLINE (MINOCIN) BECAUSE OF A LOW

WHITE BLOOD COUNT.

 

White blood cells are used to fight infection. A low white blood cell count

is clinically called leukopenia. This occurs when there is a reduction in the

normal number of circulating white blood cells in the blood stream. This

condition involves the blood and the bone marrow. Patients may demonstrate a

low

white cell count before commencing the antibiotics. This can be due to the

nature of their illness, or previous therapy such as methotrexate that causes

suppression of white blood cells, platelets and red blood cells. This is

caused by increased destruction or impaired production of these cells. Poor

quality protein intake or digestion (impaired pancreatic enzyme or HCI

production), inadequate trace mineral or essential fatty acid intake are other

causes.

 

A blood test called the Carbon test is enormously helpful at determining the

cause of the decreased WBC. The company Body Bio (888-320-8338) can provide

a clinician that can perform the test in your area.

 

A doctor may be cautious and suggest that you cease the minocycline therapy.

This is to check that this is not the trigger of the leukopenia. If the

white count returns to normal then one can resume the minocycline and observe

if

the WBC count decreases again. If it decreases again it probably is not wise

to continue with the Minocin.

 

The minocycline assists the body in clearing the infection and once the

infectious trigger which stimulates the increased production of white blood

cells

is gone, the WBC will drop to its normal non-infectious level.

 

15. MY DOCTOR HAS ME ON METHOTREXATE. DO I STAY ON THIS MEDICATION ALONG

WITH THE ANTIBIOTICS?

 

Physicians should be cautious about possible antagonism between drugs, which

could cause severe side effects. Response to antibiotic therapy depends to a

large degree on the strength of the immune system. Methotrexate is a toxic,

immune-suppressing drug, and physicians most experienced in the use of this

therapy take patients off the drug. Ideally, a six week wash out period is

recommended between stopping the methotrexate and starting the antibiotic

therapy.

 

However, if you are receiving benefit from the methotrexate, your physician

may be reluctant to discontinue it. The antibiotic therapy can be started and

then eventually gradually the patient is tapered off the drug. If you are

receiving no benefit from the methotrexate, it should be discontinued.

 

16. IS THERE AN EXPLANATION FOR THE SHORT TERM MEMORY LOSS AND PERIODS OF

DEPRESSION EXPERIENCED WITH THESE DISEASES?

 

Both short term memory loss and depression are components of the disease

process itself. As the long term antibiotic treatment of the basic problem

progresses, the depression lifts and the short term memory improves.

 

17. ARE THERE ANY OTHER THERAPIES THAT WOULD BE BENEFICIAL IN ADDITION TO

THE ANTIBIOTICS?

 

Parasite, colon, and liver/gallbladder cleanses are not only recommended,

but at times necessary to achieve optimum results from this therapy. Some

patients may need to be tested for metal toxicity.

 

18. DOES THIS TREATMENT WORK FOR FIBROMYALGIA?

 

Mixed infection is not uncommon to some of these long term chronic diseases.

 

A. Robert Franco, M.D., rheumatologist and director of The Arthritis Center

of Riverside, California, and Garth Nicholson, M.D. of the Institute of

Molecular Medicine at Huntington Beach, CA., are finding strong evidence of

mycoplasmal blood infections in a majority of their fibromyalgia patients.

Other

chronic infections may also be a source. They recommend long-term antibiotic

therapy. _www.thearthritiscenter.com/publications.htm_

(http://www.thearthritiscenter.com/publications.htm) and

_www.immed.org/illness/fatigue_illness_research.html_

(http://www.immed.org/illness/fatigue_illness_research.html)

 

Eli Mordechai, PhD at Medical Diagnostic Lab in Mt. Laurel, NJ now believes

the Lyme disease spirochete is the real culprit in most fibromyalgia patients

because while their lab finds that Lyme disease patients often test positive

for mycoplasma infections, the mycoplasma is most likely just a secondary,

opportunistic infection in a patient suffering from *late Lyme* disease.

(*Late Lyme* is chronic Lyme disease which was not caught early and which has

progressed to the late stage.)

 

Likewise, Dr. Lida Mattman, PhD, professor emeritus from Wayne State

University in Detroit, MI., and author of the medical microbiology textbook

entitled

**Cell Wall Deficient Forms: Stealth Pathogens**, has reported finding the

Lyme disease spirochete, Borrelia burgdorferi in 40% of the fibromyalgia

patients she tested. Dr. Mattman stated that if streptococcus is present, it

must

be treated first before the Lyme is treated because Borrelia feeds on strep.

In other words, the strep stimulates the growth of Borrelia. Furthermore, it

is impossible to culture Borrelia whenever strep is present because strep is

a faster growing bacterium and it will overgrow the culture medium as a

*contaminate*, obscuring the presence of Borrelia.

 

It is important to use a lab that specializes in the diagnosis of Lyme

disease. Lyme disease specialists recommend both Igenex Lab in Palo Alto, CA.,

_www.igenex.comand_ (http://www.igenex.comand) Medical Diagnostic Lab in Mt.

Laurel NJ., _www.mdllab.com_ (http://www.mdllab.com) . However, patients should

be aware that current guidelines used by these labs for testing for Lyme may

produce false negatives. The testing done by Central Florida Research

(mentioned in Section 1) should eliminate that possibility -

_http://centralfloridaresearch.com/lab2/_

(http://centralfloridaresearch.com/lab2/)

centralfloridaresearch.com .

The following websites are helpful:

_www.ilads.org_ (http://www.ilads.org)

_www.igenex.com_ (http://www.igenex.com)

_www.mdllab.com_ (http://www.mdllab.com)

 

More information on Lyme Disease can be found at _www.ilads.orf_

(http://www.ilads.orf) . There is also a discussion group for Lyme patients

located at

_www.lymenet.org_ (http://www.lymenet.org) . The patients in this on-line group

can help you find an experienced Lyme specialist who has a good track record

in diagnosing and treating Lyme disease successfully. It is very important to

select a Lyme specialist who is highly recommended by other Lyme patients,

even if you must travel a great distance to do so. Lyme disease can cause a

**lupus-like** disease pattern as well as a **multiple sclerosis-like** disease

picture, in addition to triggering symptoms of fibromyalgia pain.

 

Another frequently overlooked cause of fibromyalgia pain is toxic root

canals. The best website for information is _www.altcorp.com_

(http://www.altcorp.com) , and it has links to other similar websites for

information on dealing

with toxic root canals. A good book on this topic is **Root Canal Cover-Up

Exposed!** by George Meinig, DDS. Dr. Meinig was the father of endodentistry

earlier in the 20th century but now warns against the dangers of toxic root

canal teeth. Dr. Jacob Teitelbaum*s book **From Fatigue to Fantastic** is an

excellent resource for fibromyalgia patients. His web page is at

_www.endfatigue.com_ (http://www.endfatigue.com)

 

19. GENERAL INFORMATION

 

a)From the Physicians* Desk Reference:

- **Concurrent use of tetracycline may render oral contraceptives less

effective.**

- **Minocin pellet-filled capsules, like other tetracycline-class

antibiotics, can cause fetal harm when administered to a pregnant woman. . . .

The use

of drugs of the tetracycline class during tooth development (last half of

pregnancy, infancy, and childhood to the age of 8 years) may cause permanent

discoloration of the teeth (yellow-gray-brown).**

 

b) List of supplies need for intravenous infusion.

- 900 mg. vials of Cleocin or clindamycin

- 250cc 0.9%NS or lactated ringers. D5W should not be used because of the

candida overgrowth found in these patients.

- 10cc syringe with 21 gauge needle to draw up medication and insert in

delivery solution.

- IV tubing set

- IV needle or catheter (recommend 23gauge butterfly). Always ask for

extras.

- Tourniquet, antiseptic pads, bandaids, and tape (paper, silk, or

adhesive). Sometimes these are available as an " IV start kit " .

 

 

c) Before starting this therapy, ideally patients with these diseases should

be checked for Ð

1 - yeast overgrowth in the intestinal tract,

2 - possible low levels of DHEA and testosterone

3 - insufficient essential fatty acids, and

4 - insufficient betaine hydrochloride and pepsin necessary for digestion

 

Revised April 2007

 

Our thanks to Dr. M. R. Coker-Vann, Ph.D., Arthritis Research Center

504 E. Diamond Ave.

Gathersburg, MD 20877

Phone: 301-216-1231

for her assistance in compiling the answers to the above questions. Dr.

Coker-Vann was research director of Dr. Thomas McPherson Brown's Arthritis

Institute at the time of his death in 1989.

 

Recommended reading:

 

- The New Arthritis Breakthrough by Henry Scammell - Our book page

_http://rheumatic.org/book.htm_ (http://rheumatic.org/book.htm)

- Scleroderma: The Proven Therapy that can Save Your Life by Henry Scammell

- Our book page _http://rheumatic.org/book.htm_

(http://rheumatic.org/book.htm)

- Rheumatoid Arthritis, The Infection Connection by K. M. Poehlmann, PhD. -

_www.ra-infection-connection.com_ (http://www.ra-infection-connection.com)

- Desperation Medicine by Ritchie Shoemaker, M.D. -

_www.chronicneurotoxins.com_ (http://www.chronicneurotoxins.com)

- Detoxify or Die by Sherry A. Rogers, M.D. - _www.needs.com_

(http://www.needs.com)

- The Maker*s Diet by Jordan Rubin - _www.makers-diet.net_

(http://www.makers-diet.net)

- Dr. Mercola*s Total Health and Cookbook Program - Joseph Mercola, D.O. -

_www.mercola.com_ (http://www.mercola.com)

 

 

All references to products are included solely for the convenience of the

reader.

 

* IMPORTANT MESSAGE from A. Robert Franco, MD, Arthritis Center of

Riverside, Riverside, California.

 

Dear Patients,

 

I often find that patients that come to see me for diagnosis and treatment

for rheumatic diseases have already started on antibiotic treatment. Although

this may be helpful to the patient, it would be best when applicable to have

the appropriate work-up PRIOR to starting antibiotic treatment. I am

referring especially to the mycoplasma and Chlamydia PCR test (generic

fingerprint).

 

Antibiotics may render this test negative and thereby often making useless

this great diagnostic tool, especially in view of the fact that patients will

be obligated to use antibiotics for several years exposing themselves to some

potential toxic side effects. If you have already started antibiotics, you

should continue and consider going off for 4 weeks prior to your visit to the

Arthritis Center of Riverside, or your physician's office where these tests

may be done.

 

If it is possible to do the above, you will increase your chances of

confirming the infectious cause of your rheumatic disease. Even more so by

doing the

test prior to initiating antibiotic treatment. Additionally, your insurance

company will be more likely to authorize and pay for IV treatment if you have

a positive mycoplasma PCR test.

 

I hope this information proves useful to you.

 

Sincerely, A. Robert Franco, MD

 

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Rheumatic Diseases. As presented at the 32nd International Congress of the

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by Dr. Joseph M. Mercola. 205 References

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The following is a modified version of Dr. Brown's protocol.

_http://www.mercola.com/2000/aug/27/rheumatoid_arthritis.htm_

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_http://articles.mercola.com/sites/articles/archive/2000/08/27/rheumatoid-arth

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MEDICAL COMMENTS ON ANTIBIOTIC THERAPY

_http://rheumatic.org/comments.htm_ (http://rheumatic.org/comments.htm)

(http://www.papercut.biz/emailStripper.htm)