End Fatigue

Questions on Antibiotics and Pets

- a letter from a reader

Dear Dr T,

I saw a recent study showing that injections of arsenic based antibiotics helped horses with CFS. Do you recommend them for people as well?

Thanks,

Lester

Jacob's response:

Dear Lester,

This is actually fairly old research. It is important to keep in mind that animal models may not correlate with humans (though they may be related). On the other hand, when people have CFS, the research shows their pets are more likely to as well.

I would recommend against arsenic containing antibiotics in CFS because:

1) You do not need arsenic toxicity.
2) There are other antibiotics that we know to be effective in CFS that don't contain arsenic and which are given by mouth.

The thing to take away from this study is that hidden infections are common in CFS/Fibromyalgia, and that it is often reasonable to simply give antibiotics, even if we cannot find the infection upon testing. How and when to do this is discussed in depth in the infection chapter of the newest edition of "From Fatigued to Fantastic!", which came out 3 weeks ago. Treating with antibiotics and antivirals in CFS/FMS when appropriate is part of the treatment protocol at the Fibromyalgia and Fatigue Centers (www.FibroandFatigue.com).

In brief, I consider antibiotic therapy in CFS/FMS if (below is an excerpt from the book):

Treating the hidden antibiotic sensitive infections:
As we have discussed, testing for these infections is a very difficult and therefore it is often necessary to simply treat based on clinical symptoms. Because of this I am more likely to base my decision to treat with antibiotics based on whether any of the following are present:

1. A fever over 98.6°F—even 99°F, and/or

2. Chronic lung congestion,

3. Recurrent scalp sores which scab,

4. A history of bad reactions to several different antibiotics (people misinterpret the die-off reaction as being an allergic reaction),

5. A history of your CFS/FMS transiently improving in the past when given an antibiotic,

6. Severe vertigo. This is when you feel like you or the room is spinning in a circle and is not to be confused with the dizziness experienced by most of us with CFS, and/or,

7. Testing shows an infection.

People with these symptoms seem to be more likely to have infections that respond to special antibiotics. Fortunately, Lyme, mycoplasma and chlamydia infections, as well as many other infections that are difficult to test for in CFS, are often sensitive to the right antibiotics. The antibiotics most likely to affect these organisms are the following:

• Doxycycline or preferably minocycline, usually at dosages of 100 milligrams twice a day. These two antibiotics are in the tetracycline family. They are very effective against a number of unusual organisms (for example, Lyme disease). They sometimes cause some stomach upset. If this occurs, take the medicine with food and a full glass of water or lower the dose. They should not be given to children under eight years old because they can cause permanent staining of the teeth.
• Ciprofloxacin (Cipro), usually 500-750 milligrams twice a day. Although expensive, this is usually a well-tolerated antibiotic. It has a very wide range of effectiveness against a large number of organisms. Cipro has an additional benefit for men, as it also treats any hidden prostate infections, as does doxycycline. You should not take oral magnesium or any supplement containing magnesium within 4 to 6 hours of taking Cipro or you may not absorb the Cipro as completely. A small percent of the population has a genetic defect that prevents them from breaking down Cipro. In this group, taking Cipro can actually trigger FMS and this family of antibiotics should be avoided if you have a family member that developed fibromyalgia after taking Cipro.
• Azithromycin (Zithromax), 250-600 milligrams a day taken with food, or clarithromycin (Biaxin), 500 milligrams twice a day, taken on an empty stomach. These antibiotics are in the erythromycin family. Zithromax tends to be fairly well tolerated. Biaxin is more likely to cause a bit of nausea in some patients, but it is usually also well tolerated. They may work against infections missed by doxycycline and Cipro. Begin with this antibiotic if you have scalp or skin sores or scabs.

In addition, if testing suggests the presence of certain viral infections (they must be interpreted in a special way) the new antiviral Valcyte has been dramatically effective in the large number of CFS patients we've treated.

Love and Blessings,

Jacob Teitelbaum MD