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FREQUENTLY ASKED QUESTIONS ABOUT ANTIBIOTIC THERAPY 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. 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. 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. 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)
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