Long-term Antibiotic Treatment with Roxithromycin in Patients with Multiple Sclerosis
by R. Woessner et al, has finally been published in the October issue.
The original paper came to the conclusion that long term use of roxithromycin was no use against multiple sclerosis. Their idea of long term use was pulses over about twelve weeks. The letter pointed out the error of this and for the first time ever, talked of the use of pulsed metronidazole (flagyl) in a peer reviewed journal. So the many months of waiting on tenterhooks for this letter to appear have paid off.
Being printed as a letter, there is no abstract, but this could have been used as one:
It has been claimed that, were Chlamydophila pneumoniae a factor in the initiation, relapse and progression of Multiple Sclerosis, roxithromycin would ameliorate the disease. We disagree; macrolides alone are unlikely to eliminate the organism but instead force it into a persistent non-replicating cryptic formi, untreatable with conventional therapy. The cryptic form is likely to be a stringent response marked by a switch to anaerobic respiration, as occurs with intraphagosomal Mycobacterium tuberculosis. The cryptic form is likely to be susceptible to metronidazole. Tissue culture and mouse studies confirm this. We have informally treated a number of patients with MS with a combination of macrolides and doxycycline to induce the cryptic state, later adding metronidazole to kill it. A response akin to a Jarisch - Herxheimer reaction is not uncommon. C pneumoniae-specific antibodies often rise on treatment, indicating the liberation of bacterial antigens. In many patients neurological progression has halted and then been reversed, a rare event in the natural history of MS. We briefly report on two patients with progressive disease. This preliminary information is given here as evidence to support the theses: (a) C pneumoniae has a pathogenic input into MS (b) conventional monotherapy does not eradicate chronic infections with this organism (c) A nitroimidazole is a key component in the treatment of chronic C pneumoniae infection.
Rica and I are the two patients briefly talked about.