Antibiotic (AB) protocol has been successfully applied for decades in countries such as Netherlands, Europe and US to treat various forms of rheumatoid diseases including inflammatory arthritis such as RA, lupus, Fibromyalgia. Despite this fact, it appears that many physicians and patients are still unaware of its existence nor familiar with the numerous research, studies and clinical trials that have proven or demonstrated its efficacy in its treatment.
In an immunologic disorder such as Rheumatoid Arthritis (RA), that may incubate for years, the immune system is said to become over-reactive, as the white blood cells are activated to destroy the surrounding tissues causing inflammation. Typical treatments that are widely utilized today by the vast majority of rheumatologists include steroids, cortisone and other metabolic drugs only provide symptomatic reliefs and are often very toxic, yet do not address the underlying causative root to the chronic disease activity.
What might the Culprit be?
It has long been studied that an infectious agent is thought to initiate RA which is characterized by chronic and periodic symptoms. The concept of an infectious agent as a trigger of autoimmune disease is not new. Several microorganisms (mycoplasmas, bacteria and viruses) have been proposed as likely etiological agents for RA. The recent report that Lyme can demonstrate RA-like symptoms and can be treated with antibiotics, has attracted interested in the infectious theory.
As early as the 1950’s, Dr Thomas McPherson Brown proposed that microbial root cause should be the primary target for RA and he concluded that the latent and slow acting species of bacteria, that is the ubiquitous and unique mycoplasmas may be the viable culprit that cause persistent inflammation. In his practice, he seemed to have a treatment protocol, a plan that involves long term treatment with some form of anti-mycoplasma antibiotic group and found these protocols produced long lasting remissions.
For example, tetracyclines dosages varied from 10mg to 1000mg or from daily to weekly with oral and intravenous administration including several days of hospitalization. A significant study of 98 hospitalized RA patients treated over a 5 years period found that over 70 were substantially improved using the variable antibiotic treatment plan which was anything but standard infection plan of 1gm per day for 10 days.
What are Mycoplasmas?
Mycoplasma belong to the class of bacteria called Mollicutes. Unlike viruses and bacteria, they are the smallest free-living and self-duplicating microorganisms. They do not require living cells to replicate their DNA and growth and can colonize inside human cells.
Researchers have successfully isolated mycoplasma from synovial tissues of patients with RA. A British group found 2/3 of their RA patients to be infected by Mycoplasma Fermentens. These results are impressive since they did not include more prevalent Mycoplasma strains such as M.Salivarium, M.Ovale, M.Hominis and M.Pneumonia.
Another Finnish research reported a 100% incidence of isolation of mycoplasma from 27 rheumatoid synovia using a modified culture technique. None of the non-rheumatoid tissue yielded any mycoplasmas. The same technique also reported mycoplasma antibodies in 53% of patients with definite RA. Using similar technique, another researcher had cultured mycoplasma in 80-100% of their RA test population.
These provide additional support for mycoplasmas as an etiologic agent for RA.
The Science of Tetracycline and/or Minocycline Being Used in Antibiotic Protocol
With mycoplasmas being identified as the causative factor in RA, it had been demonstrated that tetracycline and minocycline type drugs provide some sorts of improvement in the disease activity, given that they inhibit leukocyte, macrophage and synovial collagenase.
Gradually, treatment of RA has been shifted from using tetracycline to minocycline because the latter is more potent and it penetrates the tissues better. It also benefits through its immunomodulating and immunosuppressive properties, beside from showing that it is also known to increase intracellular calcium concentrations which inhibit T-cells.
These antibiotics are so effective in suppressing mycoplasmas in RA that a reaction called the Herxheimer effect (healing crisis) develops on initial use.
The Herxheimer Reaction (Healing Crisis)
The presence of the Herxheimer reaction or healing crisis is a good reason to support the existence of the infection in the first place. The healing crisis is usually accompanied by worsening of the existing symptoms which is due to the release of excessive mycoplasmas antigens or internal toxin contents into the sensitized human host tissues following the antibiotic therapy.
According to Dr Brown, the mycoplasmas attach a barrier around itself that keeps out the immune system but both tetracycline and minocycline work by suppressing this barrier which forms the mycoplasmas means of defense.
Dr Mercola also found that those patients following his protocol and prescribed nutritional guidelines rarely experience prolonged healing crisis, which include supplementation of Bs, C, D alongside with limiting sugar among other strict dietary guidelines.
Dosage and Administration of Drugs
Basically, there are 3-prong prescriptions:
- Antibiotics: such as tetracycline or minocycline, in low pulsed doses aimed at inhibiting the microbial cause and preventing the disease, also acting as antioxidants, immunosuppressants and protein synthesis inhibitors. Usually, 100 mg of minocycline administered twice a day. If tolerated, it is ideal to take it on an empty stomach, first pill at mid-morning (2 hours after breakfast) with a glass of water and the second dose at bedtime.
- Immunosuppressants: such as low dose prednisone, which blocks the immune-complex formation and the activation of Complement which promotes tissue destructive inflammation. Usually, 7 to 5mg of prednisone may be administered simultaneously with the antibiotic. Preferably, no more than 10mg should be administered for flares. Dosage must be kept low to prevent interfering with the immune system but high enough to reduce the hypersensitivity or allergic inflammatory reaction of the disease activity.
- Anti-inflammatory antixosidants: such as dietary supplements and NSAIDs, which eliminate and prevent tissue destructive inflammation. The concomitant use of NSAIDs varies.
1. Titration of the antibiotic dosage
2. Treatment complex to be given in interrupted fashion
3. Aim to phase out steroids in time
Early encountered problems typically comprise headaches and dizziness, which usually abate with time. Quite rarely minocycline can cause drug-induced hepatitis or pneumonitis. However, the more apparent side effect of long term administration of the antibiotics is the minocycline-induced hyperpigmentation. The skin that are usually exposed to sun may develop patchy or general darkening. The gum, teeth and conjunctiva of eyes can also darken.
Clinical Studies and Findings
An independent group of biostatisticians reviewed the risks benefits in the treatment of all patients admitted to the National Hospital by Dr Brown over the five years from 1978 to 1983 and these evaluations demonstrated:
- 84% of patients reported an improvement of 50% or more in their joints and morning stiffness
- 75% of patients reported symptomatic improvement with respect to weakness, fatigue, depression and feeling of well being.
- An unexpectedly positive and statistically significant correlation between duration of treatment and improvement observed.
- Patients on AB protocol were able to reduce or discontinue corticosteroid therapy.
- 70% of patients remained on AB therapy 5 years after starting treatment versus only 10-20% of patients treated with gold who remained on that drug for 5 years.
- No serious toxicity and side effects developed.
Quoting the authors, the risks and benefits from the long term AB treatment are substantially more favourable than historical experience reported for using conventional slow acting drugs such as Gold, Plaquenil, etc.
In 4 decades of experience with antibiotics, Dr Brown noted significant benefits from AB protocol required on an average of 1 to 2 years. It was common for patients to experience worsening of condition during the first few months prior to improvement. Some others experienced improvement as soon as 6 months into the therapy. In other word, the effectiveness of the therapy is also highly dependent on the extensiveness of the disease and duration of the therapy. There was no surprise to note severe cases where it took up to 30 months for the patients to gain sustained improvements.
The primary takeaway for AB protocol is that once remission is established, it is generally permanent and it takes persistence and cooperation with the practitioner to determine the right combination of antibiotic dosage and method of administration which includes management of sensitization to the antigens. Factors such as age, gender, and genetic susceptibility all contribute to either help, hinder or predispose the therapeutic success and for optimal results, the treatment plan must incorporate variable factors such as diet, health, exposure, physical and mental stress and for such plan to be individually adjusted. Even though symptoms may be similar for two persons on the surface, the underlying mechanisms may be totally different.
When remission becomes established, the antibiotics may be gradually phased out. When flare ups occur, short courses of antibiotics should be given until no longer needed.
The following criteria help to establish remission:
- A decrease in duration of morning stiffness to no more than 15 minutes
- No pain at rest
- Little or no pain or tenderness on motion
- Absence of joint swelling
- A normal energy level
- A decrease in ESR to no more than 30
- A normalization of patient’s CBC
- ANA and RF titers returning to normal
Dr Brown and his associates had accumulated significant evidence that mycoplasmas were at root of RA and that the above group of antibiotics can kill or radically suppress mycoplasmas and their growth. When administered in a low, controlled dose over a long period over months or years, depending on severity of condition, they could help RA conditions to improve and gradually bring the infections to within manageable bounds.
Since Dr. Brown’s death, many physicians have been prescribing the AB protocols for their arthritis patients and gained additional insights into improving the success rate of the treatment. For instances, some physicians determined that limiting sugar is critical in the treatment program because sugar has multiple significant negative influences on a person’s biochemistry through elevation of insulin levels and impairment of intestinal microflora.
Others found that patients should not consume certain mineral supplements when taking their antibiotics. For example, iron. Over 85% of the dose will bind to iron and pass through the colon unabsorbed. Another examples are magnesium and calcium. Their interaction with the antibiotic also prevent them from working effectively.
In many cases where one antibiotic is not effective, another (or a combination of antibiotics) may work equally well for the same patient.
I have not personally tried AB protocol before due to a lack of access to physicians who prescribe it. The protocol needs to be maintained long term, usually for years; and financially, I do not deem it viable for me to fly out of town, say on a monthly basis, for years to the nearest physician overseas for appointments and follow-ups.
This is an awareness post, and I cover this, nonetheless, with the belief that this information may be useful and valuable to people in search for an answer to probably some of their RA questions. If you wish to learn more of Dr Brown’s AB protocol in greater details, there are abundant of information, studies and research that can be found at its official site – the Road Back Foundation’s site. The RBF website contains an ever growing number of databases of testimonials of patients who have reclaimed their lives due to the AB protocol as well as information and support on this protocol, forums and other important but often overlooked treatment options.
I understood that there are successes and failures for some patients who have tried out AB protocol before. If you are currently on this protocol or have done it before, I’d like to invite you to share your experiences and advices/comments on them.