Transient improvement from antibiotics - help be troubleshoot

[redo]

I have been sick for almost a decade. And I have this strange reaction I'd like your opinions on.

When I begin on various antibiotic cures - I improve greatly for some days - and then I slip back.

This has happened with minocycline, ceftriaxone, clarithroymcin, ciprofloxacin and other antibiotics.

Now this is what happens; I begin on the antibiotic, it goes a day or two, and suddenly I feel better. Much better. It lasts for some days, before it fades away.

Here are my thoughts on why this happens:
Hypothesis 1)

All of those antibiotics have immunomodulatory effects. I have tests displaying a immune system out of balance. When the antibiotics are given, this modulates itself in the right direction, and I improve.

There's a reason why the immune system is out of balance. It might be the virus keeping it out of balance, or it might be the body which tries to fight a virus, and therefore is 'overactive' (and thereby out of balance).

Whatever reason for the unbalance, either if it's a virus causing it, or the body responding to a active virus. It adjusts itself back, after I modulate it with drugs.

So if the drugs get the immune system under control for some days, then the body will adjust it back, because the body feels "it needs to keep it that way, because of the infection".

And when that happens - I feel worse again.

Hypothesis 2)
What happens when I get the antibiotics is that the antibiotics themselves fight off unwanted bacteria in the colon/gut. Those bacteria causes immune dysfunction, so when the bacteria are fought, the immune system gets better.

This only works for some days, and then I slip back.


There are some things which point away from hypothesis two, and that is that I can't think of a reason for why the treatment would only work for some days. If it was because of bacteria fighting effects in the colon/gut, it should continue to work when I continue to take it. And if it's resistance (which I doubt can happen in just days) then I find it strange that the same antibiotic works again the next time I take it (if there is some time since last time I took it).

And -- several antibiotics have made me feel significantly better within the same day as I begun taking it (penicillin G and ceftriaxone). The same day. That is also something which points away from hypothesis two.

The only thing I can think of - which happens the very first days as a antibiotic is taken, is that as soon as it's up in the blood stream, it begins modulating the immune system. This is true for many antibiotics.

Clarithromycin's direct effects on the cytokine balance.

Ciprofloxacin's direct effects on the cytokine balance.

There are many others, I could look them up, but it proves the point. Most antibiotics do have direct effects on the immune system (not going via antimicrobal activity).

So, I'd appreciate your thoughts on this. Am I onto something?

 

[Live And Let Die]

Redo - I am exactly the same way. Much much better on antibiotics then slip back when I'm off them.

 

[perovyscus]

Yes, you may have come to the correct conclusion from an immune point of view. As far as the transient nature, it's difficult to say. An antibiotic may cause so much negative feedback on the Th2 system that it briefly shuts it off. In addition, the minute amount of bacteria is now being taken care of and eliminated from the body.

So, now you are removing bacteria. Some could argue they are beneficial beneath sepsis to stimulate the Th1 portion of the immune system. And now your abx is reducing your interferon gamma and tnf, necessary to remove viral infections.

Your feeling better is probably linked to temporary interferon gamma reductions until the body accommodates the new drug. Or it's all in your head, but that's my brief guess. Am I right? Am I right? Anyone? :Sign Good one:

 

[redo]

Thank you for your reply. It's so important for me to have someone to "play ball with" when it comes to figuring this out. I think there lies an important 'clue' in this.

May I please ask which abx you feel better while you are on? (I feel better on most, but not on doxycycline).

I also get a strange sort of "better on some symptoms, and a LOT worse on others" when I get a normal viral infection (influenza). That seems to fit well on hypothesis one.

It may fit on two also, but I find it weird that I should get better so quickly, and slip back again (despite still going on treatment) if all of this has to do with what's described in two.

 

[wciarci]

Minocin got me back on my feet

I believe that my partial recovery was due to three years of minocin treatments, followed by some anti-virals. I am on my way down again, and will try to get my PC to consider minocin. I was initially put on this medication by a Boston rheumy for what he thought was scleroderma, although I know question this diagnosis as many of the symptoms correspond to CFS. In fact I no longer had a positive ANA for many years. The good doctor in Boston explained that minocin is an immune modulator that gets the immune system to stop attacking itself. I don't know if any trials have been undertaken with CFS.

Wendy

 

[glenp]

I can't figure it - maybe our experiences will help you figure something!!!

Years ago I was on IV antibiotics - revolving and sometimes changing them after a few days - gentamicin did permanent damage - moxalactin really helped. I was on them IV for 6 months and actually felt good after that

After that I was on stints of up to 6 weeks of oral antibiotics - 3 or 4 times a year. I then stopped getting infections, flus, colds, pneumonia, bronchitis, abcesses etc. so had no antibiotics. I then got sicker. I feel that over the years the antibiotics kept this illness at bay.

Last June I started taking minocycline 100mg daily it helped and I upped it to 200mg - I stayed on for 6 months but stopped because of noise in my ears and was afraid that it may be doing inner ear damage. It helped me a lot - drastic improvement in migraines, soar head, ability to add numbers and I no longer smell horrid odors that are not there. Its been 2 months and the improvement is still there

glen

 

[Mya Symons]

There is another thread here where someone posted a paper that talks about the anti-inflammatory effects of antibiotics. If you can find that one, it is interesting. I was in the hospital recently with a post-op infection and they put me on a variety of I.V. antibiotics. I have been in pain for over 11 years now without a break. But, during the time I was on those I.V. antibiotics I did not feel any pain at all, not even from the post-op infection. For a day or two I had wishful thinking and thought maybe I had an all over bacteria infection that was cured. But, as soon as I was off those antibiotics for a couple days all my symptoms came back. It is probably not good for the body to be on antibiotics for a long time. My docotor kept on monitoring me for pseudomembranous colitis while I was on them. However, perhaps they should start studying the anti-inflammatory effects of antibiotics and maybe they could reproduce that without all the side effects of taking an antibiotic for a long time.

Regarding the possibilty that you feel better for a few days because the antibiotic is fighting off bacteria, but it only lasts a few days: Could you be herxing? Some bacteria, when it dies off, what is left of the bacteria is somewhat poisonous to the system and must be filtered out. This can make you temporarily feel sicker. People with Lyme disease go through this often when taking antibiotics.

I had many different antibiotics while I was in the hospital, but I believe the one I noticed the most difference with (as in the pain went away) was Rocephin (ceftriaxone).

 

[FunkOdyssey]

I believe that my partial recovery was due to three years of minocin treatments, followed by some anti-virals.

Wendy

What was your dose of minocycline over those years?

 

[heapsreal]

my experience with doxycyline and mino was that initially i felt like crap, worse then normal, so i would take a day off and feel really good. Then i would start again, the first day or 2 werent bad but day 3 i was crappy again and take a day off and feel better and i would repeat this cycle. Eventually i could take it more days in a row but i would only feel better on the days i was off, that is better then pre abx but crappy when on, so maybe some type of die off or IRIS reaction. I never had any sustained improvements but it did get me out of a hole a few years ago. I possibly had some type of bacterial co-infection. I also think its anti-inflammatory effects helped too, but our bodies(cfs) seem to adjust to alot of these meds and supps we take, it seems alot of cfsers respond better to pulsing alot of different meds not just abx. Doxy also helped my chronic red eye problems, but again not sure if its from reducing infections or anti-inflammatory effects.

cheers!!!

 

[FunkOdyssey]

Well I've heard this particular story about recovering after years of minocycline enough times that I've begun to give it some serious consideration.

 

[FunkOdyssey]

Last June I started taking minocycline 100mg daily it helped and I upped it to 200mg - I stayed on for 6 months but stopped because of noise in my ears and was afraid that it may be doing inner ear damage. It helped me a lot - drastic improvement in migraines, soar head, ability to add numbers and I no longer smell horrid odors that are not there. Its been 2 months and the improvement is still there

glen

It's important to take B6 preferably in the form of P5P to prevent ear damage when taking minocycline long term.

 

[wciarci]

Hey FunkOdyssey,

I am trying to remember through this awful fog. It was either 100 mg (50 in the am, 50 in the pm) or 200. I remember it had to be name brand, my doctor was adamant about this, generic didn't work. Hope this helps.

Wendy

 

[Cloud]

I have been trying to answer this question for at least a decade. I have known for at least that long that I experience immediate, yet only short term relief with certain antibiotics. I have always had the best response with Azythromycin, but then some of the other "myocins" and "cyclines" work too. I had always thought it to be an undiagnosed bacterial infection. The idea of immune modulation has only come up in the last few years, but it does make a lot of sense. The biggest clue in my mind adding to this theory is that I have a very significant and sometimes profound improvement within 24 hours. That doesn't happen killing bugs.

Redo, I have been looking at the same 2 possibilities. Recently, I tried Cipro for 2 reasons: First because it is the next best thing to Rifaxim which is being used to treat the culprit involved with the H2S problem (and I've always had a major GI component). Second, because it's not in the family of antibiotics most reported to cause immune modulation. Well, I had a profound response to the Cipro. I was 80% improved, with zero PEM, for about a week...and then the same old plateau in progress until effectiveness ceases. I'm sure the same decline will once again happen now being off the Cipro. I plan to run this by Dr Peterson when I see him next, but my experience is that he's unsure of why this is happening.

Anyhow, my experiment did not rule out or diagnose either, like I had hoped. But why we respond to antibiotics like this is a question that needs answered. I would truly like to see this thread continue. For now I would add one more possibility: It is an undiagnosed infection, but we only get partial relief because it's an antibiotic resistant bug. But, I still do lean slightly more to the immune modulation theory. If it is immune modulation, we need to find immune modulators with the closest immune modulatory action.

 

[pine108kell]

There have recently been several threads on this so will not repeat too much here.

I have experimented with many antibiotics for years. These fast responses to antibiotics (a few hours to few days) are, IMO, almost certainly because of a reduction in inflammation. It can be a very profound and significant clearing effect. The length of time of this clearing is related to factors I'm sure I do not understand, but also to the half-life for the antibiotic. Zithromax has a very, very long half life (several days), so you can get benefits long after taking it. Minocin is in between (about half a day); some others like amoxicillian are very short (few hours).

The second component is, of course, the killing of chronic bacterial infections. This also happens with many of us with those infections. Instead of feeling better, you will start feeling much worse after a few days or so because of herx reaction. This will following the "clearing" feeling you can get initially--it takes a while to kills the bugs, build up the toxins from their dead bodies and then trigger the immune response. Antibiotics can be helpful here too for long term improvement (as opposed to the short term anti-inflammatory response), but it is a long painful road, and nothing like a cure. It may or may not be worth it.

Maybe this is not the pattern for everyone, but this is one facet of my illness I am actually pretty sure I understand on a general level.

 

[Cloud]

There have recently been several threads on this so will not repeat too much here.

I have experimented with many antibiotics for years. These fast responses to antibiotics (a few hours to few days) are, IMO, almost certainly because of a reduction in inflammation. It can be a very profound and significant clearing effect. The length of time of this clearing is related to factors I'm sure I do not understand, but also to the half-life for the antibiotic. Zithromax has a very, very long half life (several days), so you can get benefits long after taking it. Minocin is in between (about half a day); some others like amoxicillian are very short (few hours).

The second component is, of course, the killing of chronic bacterial infections. This also happens with many of us with those infections. Instead of feeling better, you will start feeling much worse after a few days or so because of herx reaction. This will following the "clearing" feeling you can get initially--it takes a while to kills the bugs, build up the toxins from their dead bodies and then trigger the immune response. Antibiotics can be helpful here too for long term improvement (as opposed to the short term anti-inflammatory response), but it is a long painful road, and nothing like a cure. It may or may not be worth it.

Maybe this is not the pattern for everyone, but this is one facet of my illness I am actually pretty sure I understand on a general level.

I hear it's a pretty common pattern. I've heard it a lot over the years. I've been on long term abx tx 3 times, different abx eveytime. Everyime it's the same pattern. It's the same pattern everytime with with short term use as well.

Pine, it sounds as though your convinced it's Immune modulation/anti-inflammatory....have you found anything else that works as well as abx? We can't take abx long term even if they did continue to be effective (which they are not) as an immune modulator.

Many consider this phenomenon to be Chronic Lyme....I don't feel that fits me.

Pine, I thought those other threads didn't make it far...if you know of a good one, please link me up.

 

[pine108kell]

I've asked the same question about finding something else that has the anti-inflammatory properties of antibiotics. Someone recently suggested Benicar (a cheap blood pressure medication), which does seem to have these properties. I took this years ago, felt better at first and then I started feeling strange, much worse, but in a different way than antibiotics after taking it for a while. I don't know what others experiences are with that drug. Then there are the usual herbs etc., that never seem to pack the same punch--although I do feel that the Quercetin/Bromelain combination helps me some. Even just trying to find symptom relief--this is just another area of neglect for those of us with this disease.

Here are two threads that discuss this topic. I think there is at least one more--maybe search for Minocycline and HIV--there was a paper on how it was used to alleviate brain fog by reducing inflammation for those with HIV and it is posted somewhere on this forum.

http://forums.aboutmecfs.org/showth...ory-and-other-positive-effects-of-antibiotics
http://forums.aboutmecfs.org/showthread.php?9291-Minocyclin&p=149945#post149945

 

[Cloud]

I've asked the same question about finding something else that has the anti-inflammatory properties of antibiotics. Someone recently suggested Benicar (a cheap blood pressure medication), which does seem to have these properties. I took this years ago, felt better at first and then I started feeling strange, much worse, but in a different way than antibiotics after taking it for a while. I don't know what others experiences are with that drug. Then there are the usual herbs etc., that never seem to pack the same punch--although I do feel that the Quercetin/Bromelain combination helps me some. Even just trying to find symptom relief--this is just another area of neglect for those of us with this disease.

Here are two threads that discuss this topic. I think there is at least one more--maybe search for Minocycline and HIV--there was a paper on how it was used to alleviate brain fog by reducing inflammation for those with HIV and it is posted somewhere on this forum.

http://forums.aboutmecfs.org/showth...ory-and-other-positive-effects-of-antibiotics
http://forums.aboutmecfs.org/showthread.php?9291-Minocyclin&p=149945#post149945

I've been considering Quercetin/Bromelain. Maybe next supplement order, I'll get some. Thanks for the links too.

 

[redo]

Hypothesis 2)
What happens when I get the antibiotics is that the antibiotics themselves fight off unwanted bacteria in the colon/gut. Those bacteria causes immune dysfunction, so when the bacteria are fought, the immune system gets better.

This only works for some days, and then I slip back.

There are some things which point away from hypothesis two, and that is that I can't think of a reason for why the treatment would only work for some days. If it was because of bacteria fighting effects in the colon/gut, it should continue to work when I continue to take it. And if it's resistance (which I doubt can happen in just days) then I find it strange that the same antibiotic works again the next time I take it (if there is some time since last time I took it).

It might be that the positive effect which comes the very first days are due to a direct (positive) impact the abx has on the immune system. But the improvement which comes later on in the run is because the antibiotics works directly to kill off bacteria in the gut/colon which makes us worse.

 

[Live And Let Die]

Since antibiotics have a long half life and the benefits seem to plateau, what about cycling them? x days on x days off ect.

 

[pine108kell]

Since antibiotics have a long half life and the benefits seem to plateau, what about cycling them? x days on x days off ect.

If you don't have a herx reaction, which I do, taking one or two zithromax a week would probably be palliative for many. It might have other side effects though as it is kind of rough on the gut and who knows what else. I have to admit that if I did not have herx reactions it would be hard to resist pulsing antibiotics on a more regular basis than I currently do.