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The oral antibiotics used with Inflammation Therapy (IT) are carefully selected with safety and efficacy in mind. They’re administered in a pulsed fashion at minimum inhibitory (MIC) doses. They act synergistically on different bacterial ribosomes to weaken intracellular bacteria so the Benicar-upregulated immune system can eliminate them.

Importance of antibiotics

Some patient-to-patient message boards state that Benicar alone can activate the immune system enough to kill all the offending intracellular bacteria that cause chronic inflammation. However, there's no evidence to support the claim that antibiotics are optional to recover from chronic inflammatory illnesses. Based on our extensive experience with clinical management of IT, Chronic Illness Recovery (CIR) medical professionals firmly believe that antibiotics are essential to the recovery process.

Biochemistry

We believe that in chronic intracellular infections, vitamin D receptor (VDR) expression is down-regulated (impaired) by bacterial actions which inhibit the immune system. IT antibiotics help rebuild VDR competence (and restore effective immune system function), by weakening the bacteria to help the immune system eliminate them. In over 15 years of counseling patients, we have never seen a case in which Benicar alone was adequate to up-regulate (activate) the VDR to transcribe enough anti-microbial peptides (the body's natural 'antibiotics') to clear the chronic infection. See Vitamin D.

Herxheimer reaction or disease symptoms?

Some patients report experiencing Herxheimer reactions on Benicar alone, but without the effect of pulsed antibiotics, it can be difficult for patients to know if symptoms are due to herxing or the disease process. An increase in symptoms, in response to the pulsed antibiotic schedule, provides evidence that symptoms are due to herxing rather than disease progression.

Sometimes patients discontinue antibiotics because Herxheimer symptoms are intolerable. Although stopping antibiotics is often followed by a brief symptom respite, usually the consequence of prematurely discontinuing antibiotics is often the return or exacerbation of intolerable symptoms and/or worrisome lab test results. This is because the immune system has not been able to kill all the bacteria and resolve chronic inflammation.

It's also important to use the correct dose of Benicar. At high doses Benicar partially blocks the Nuclear Factor kappa-B cytokine pathway (as prednisone and other steroids do). Blocking this important cytokine pathway can reduce symptoms but this pathway is essential for the normal chain of immune responses. Thus, a lower dose of Benicar may be more effective to eliminate the intracellular bacteria and control other pathogens. See Benicar Dosing to Prevent Organ Damage During Therapy.

Some patients may have been told they're in a so-called Stage 5 of recovery and antibiotics are no longer necessary. Feeling better on Benicar alone does not necessarily mean recovery. If reduced symptoms are merely due to a suppression of Nuclear Factor kappa-B with high-dose Benicar and a lack of herxing, then progress is not being made toward killing the intracellular bacteria and a true recovery of health.

Antibiotics modulate the immune system response

Many patients report they're able to tolerate herx symptoms better as they wax and wane with the correct dose and schedule of appropriate antibiotics, rather than the symptoms they experience with no antibiotics.

Antibiotics can cause a shift in immune cell subsets, and thus can modulate immune responses without causing immunosuppression. The antibiotic/s or dose or schedule should be adjusted until a regimen is found that maintains tolerable herx symptoms while ensuring a continued, controlled bacterial elimination. See Immunomodulatory Properties of Antibiotics.

Bacterial susceptibility

Some intracellular bacteria are more affected by one antibiotic than another and some are more affected by combinations of antibiotics. Similarly, different dose of antibiotics weaken different bacteria. By slowly ramping antibiotics upward, and adding other IT antibiotics, the whole spectrum of susceptibility may be covered.

The low antibiotic doses are taken long enough for the immune system to eradicate the pathogens most susceptible to low doses, and the higher doses are then used to allow the immune system to kill the pathogens susceptible to the higher doses. This slow, careful process also controls the severity of the Herxheimer reaction because it prevents too many pathogens from being killed at one time. Using this strategy, all the IT antibiotics are safe to use. This cautious approach also ensures that the host (patient) suffers minimal effects from secondary inflammation while the pathogens are slowly killed and all intracellular bacteria are eventually eliminated.

Antibiotic resistance

Antibiotic resistance during Inflammation Therapy is avoided by:

• Using only antibiotics that target L-forms (cell-wall-deficient bacteria)

• Pulsing low doses of these antibiotics – often below the minimum inhibitory concentration (MIC) to prevent the creation of "persister cells"

• Varying combinations of antibiotics to reduce the likelihood that bacteria will develop resistance

Dysbiosis

Microbial colonies found on or in the body carry out a series of helpful functions, including protection from the penetration of pathogenic microbes. Microbial balance can be disrupted (dysbiosis) by inappropriate antibiotic exposure and lead to an overgrowth of one or more of the disturbed colonies. Patients who are concerned about gastrointestinal dysbiosis may take probiotics.

High-throughput analysis of the impact of antibiotics on the human intestinal microbiota composition (full text available upon request)

In general the impact on the microbiota is antibiotic and dose dependent, even if antibiotics belong to the same class. Within a bacterial group, a specific antibiotic can have different impacts for different species and the dose of this antibiotic can influence specific species within a bacterial group. Prominence or absence of certain species might have an influence on the ecosystem and, therefore, on human health. For instance, L. gasseri that became predominant upon a treatment with amoxicillin, ciprofloxacin and doxycycline has been shown to result in a significant reduction of inflammation in IL-10-deficient mice. A minimum inhibitory concentration (MIC) can influence some bacterial groups of the microbiota and could have consequences for colonic health with respect to development of resistant bacteria and may cause disturbance of colonic fermentation. A sub-MIC dose of antibiotics reaching the colon should not be under estimated but the risk must be weighed against the benefit.

Therapy must be individualized

Individual response to treatment precludes a simplistic, one-size-fits-all model. Each patient will react a little differently to different doses of antibiotics, depending on various factors (e.g., bacterial species, bacterial load, function of the immune system at that point in time, etc.). Thus, patients need guidance from medical professionals who are experienced in the management of Inflammation Therapy, to maintain tolerable herxing and ensure a safe recovery.