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Wednesday, March 18, 2009

Long term antimicrobials for non-Lyme disease

Long term antibiotics are and have been used to treat a wide range of medical disorders. It seems the use of long term antibiotic therapy is acceptable for other conditions, except Lyme disease.

Rheumatoid arthritis: Doxycyline and Minocycline have been shown to be effective and used as maintenance drugs. Plaquenil, an anti-malarial antimicrobial drug which is frequently used for the treatment of Lyme disease, is also used long term in the treatment of rheumatoid arthritis and systemic lupus erythematosis.

Periodontal disease: Periostat- a formulation of Doxyclyine has been approved for long term use.

Acne: Doxycycline and Minocycline are frequently used for months and years. Acne, unlike Lyme disease, is a cosmetic disease, not a disabling or life threatening disease. Other antibiotics like Bactrim have also been used.

Chronic prostatitis: Cipro and similar antibiotics are frequently prescribed for 90 days and longer.

Urinary tract prophylaxis: Women with recurrent urinary tract infections have been treated with long term antibiotics to prevent recurrences.

Chronic otitis media- ear infections: Long term antibiotics have frequently been prescribed in children to prevent recurrent ear infections. Although this practice has been discouraged in recent years, current peer reviewed studies have again supported the benefits of this therapy.

Chrohn's disease: Antibiotic therapy, at times long term with Cipro and at time Flagyl, have proved to be beneficial, and safer than other recommended therapies.

Rheumatic fever: For patient with recurrent Rheumatic fever related to Steptoccocal infection, the use of Penicillin orally or by injection, on an indefinite basis has been recommended.

PANDAS: Pediatric Autoimmune Neurological Disorder: This disorder associated with OCD disorder and tics, especially in children, has been treated with long term antibiotics such as Penicillin. Although there may be controversy regarding this therapy, no psychiatrist has had medical board sanctions for prescribing this therapy.

Chronic osteomyelitis- bone infection and diabetic ulcers: Frequently treated with long term or indefinite antibiotic therapy.

Chronic constipation: Gastroenterologists frequently prescribe indefinite Erythromycin for the management of refractory constipation.

Herpes simplex: Valtrex, an anti-viral medicine is frequently prescribed indefinitely for this benign condition.

Toe nail fungus: Lamisil, a potent and potentially toxic antifungal, is routinely prescribed for 90 days for this cosmetic condition.

Q fever: May be a chronic bacterial infection requiring 4 years of antibiotic therapy.

Whipple's disease: Another chronic bacterial infection which routinely requires years of antibiotics and may be fatal.

TB: 6 months of a potent antibiotic, toxic to the liver, is frequently prescribed to prevent TB after exposure.

Active TB: 6 to 9 months of triple antibiotic therapy is required. In the recent past therapy was frequently extended for 2 years.

Coronary heart disease: Associated with elevated C-reactive protein. This is a circulating protein associated with activation of the complement cascade. This is an effector mechanism of the innate and acquired immune system responses. Chlamydia pneumonia, a chronic intracellular bacteria has been found in blood vessel plaques. Long term antibiotics have been studied for this disease.

Malaria: For persons in endemic areas long term antimalarials is frequently employed.

MS and other autoimmune neurodegerative disoders: The use of long term Minocycline and other antibiotics is an area of active research.

This list is by no means comprehensive. But is sure demonstrates the existence of a double standard.


MJ said...

Tonsils infection: had one complete year of Benzetacil (penicillin) 1'200,000 Intra muscular injection every other week! The they made the surgery... makes no sense. No one questioned the length of the antibiotic treatment; by the contrary everyone said it was necessary, was the best, etc.

lyme4achange said...

Of course it is a double standard.

Someone emailed me just this week about a bill in the state of WV that was going to allow for insurance companies to have to cover lyme treatment, even when long term. And that the IDSA supposedly sent a letter to the state representative saying that long term antibiotics for this condition does more harm than good.

I'm not into the whole conspiracy theory thing...I have always thought this whole mess has been driven by a few very large egos...but my GOSH even I am starting to wonder sometimes WTF is going on here, really.

However, since we are all having this big conversation re: long term antibiotics and the benefits...and I am by NO MEANS against antibiotic use long term...I do believe it is the only way...I did doxy followed by tertracycline followed by mino over the course of a year. tried a few other antibiotics in the meanwhie that I either had allery to (zithromax) or bad side effects (biaxin/clarythromycin).

However I am discouraged by my current relapse that started in spetember. Lack of funds is the number one prevention to getting help right now. But I do not want to spend the rest of my life on tertracycline, either. To be honest I don't know if I believe we have an oral antibiotic that can completely clear a very very very late long term infection in my brain and nervous system. *shrug*

And that scares me. Its been over 20 years since we knew what bug causes this and still we do not know what REALLY effectively treats it. Everyone seems different, some do better on different antibiotics than others do. Some people respond better than others.

Good doctors like yourself do the best you can with what you have to offer. I appreciate that. And you try to remain realistic and logical through it all.

Thanks for putting out there several other conditions that are treated long term.

lyme4achange said...

Oh said:
"Acne: Doxycycline and Minocycline are frequently used for months and years. Acne, unlike Lyme disease, is a cosmetic disease, not a disabling or life threatening disease. Other antibiotics like Bactrim have also been used."

Yes...and no.

The person I knew who was on LT tertracycline for acne had acne vulgaris, a VERY painful and disfiguring form of cystic acne.

He had skin cysts from acne from age 12 through his adulthood and today at 40, some the size of my fist. Multiple lancing and operations have been required and the disfigurement and pain are very real. While it won't kill him, its an awful awful condition to have.

I hate to be a pain in the butt about it...and I know that sometimes it is given just for moderate acne to clear the skin which is VERY cosmetic...but most people do not know that some kinds of acne treated with antibiotics are very severe.

Its simply a pet peeve of mine, knowing how he had always suffered with this condition, that many people are under the impression that acne is always cosmetic.

Lyme report: Montgomery County, MD said...

You don't die of acne.

Accutane is much more effective.

john said...

I have had Lyme now for 7 months. I have a positive Western Blot and Eliza. I saw the tick, stupidly crushed it, and a month and a half later became severely ill with the rash. I was given 3 weeks of Amoxicillin by my regular doctor and told I would be fine, well I wasn't.

I have gone to two ILADS doctors since then that are on my isurance plan. I can't afford the ones near me off the insurance plan since they charge like a grand for the first visit and the drugs aren't covered.

One had me on 100mg of doxycycline twice a day and the other 250mg of Zithromax once a day. I haven't seen any improvment.

From what I've been reading on this site and other places this isn't enough medication.

I ask you are the hands ILADS doctors that take insurance tied?
Is it a bad move to go that route.

It has been 7 months of hell.

lyme4achange said...

I agree that you don't die of acne. Unless you had an open sore from having a cyst lanced and anded up with a secondary infection that was harder to treat, I suppose. Just that in some cases its not just cosmetic. I was just saying that one type is very painful and life altering.

Some people cannot take accutane and it does have some horrible side effects on others. Like I said, sorry. Not trying to be a jerk. I think you're pretty cool overall, I just disagree on this point. Only because I cared about someone with this particular condition and hate to see anyone in chronic pain.

Possibly its MY problem because I am currently cranky and discourgaed.

monkey girl said...

I was just discussing this with my husband. I remember my mother being on doxy for years for her adult/menopause acne. No one ever questioned it. Yet being prescribed doxy for Lyme for longer than 3 weeks is 'not-advisable'. I just don't get it.