Hi,

My husband has a new doctor who seemed quite open, I asked about taking antibiotics and he gave my husband a 2 week perscription for Amoxycillin & Clavulanic 500/125 x 2. Nilstat (antifungal) and probiotics.

The day after starting this my husband has improved dramatically and after 4 days can walk easily.

My husband is on a NSD/ no diary for 6months time with little effect, CRP & ESR last test was 120+. He still continues to take Naproxyn, prednisone, SSZ.

I know a fast would be best and to stop all Naproxyn but my husband will only do if instructed by his Doctor.

I have read in Dragon's AP that Amoxycillin has no effect on the Kleb's- then I wonder why is my husband getting better? Do you think that maybe it's just the Nilstat stopping the Candia.

What should my husband do next? Should I try and ask for a new type of Antibiotic from his DR- if yes which one please. He has also been prescribed probiotics- should he only take them after he's finished with the antibiotics or while on antibiotics.

Any feedback is really appreciated.

Thank you so much for your time and patience everyone.
Regards,

Emily

Hi Emily,
I work in a Microbiology lab so I can answer this one.
Klebsiella pneumoniae is always resistantant to Amoxycillin (otherwise known as Ampicillin). However, when Amoxycillin is combined with Clavulanic Acid the two act synergistically and the combination (often referred to as Augmentin, presumably because the Clavulanic Acid is AUGMENTING the Amoxycillin) is often active against bacteria for which Amoxycillin alone would be ineffective.
Most (but not all) strains of Klebsiella pneumoniae will be sensitive to Augmentin (Amoxycillin + Clavulanic Acid).

The antifungal agent is presumably to prevent an overgrowth by Candida which may result from using the Augmentin in much the same way that women on antibiotics often develop Thrush.

Some people might add Flagyl (active against anaerobes) to prevent what's called psuedomembranous colitis which is caused by an antibiotic induced overgrowth by an anaerobic bacteria called Clostridium difficile. This condition often causes diarrohea in patients in a hospital setting.

I remember from my dim, distant past that the faeces is made up principally of anerobic bacteria.

Cheers David P.

Great to hear that he is feeling so much better in such a short period of time.... it sounds like he has been in a bad way for a while, with such elevated results still.

In taking both antibiotics and an antifungal at the same time it will be hard to work out which is having the biggest effect... If candida might be a problem, then adding that aspect of the diet in and seeing what happens would be one option. I have read that while taking antifungals it is best to cut out sugars and things that feed it to get maximum results. As with many things, it may take time to see results....
Dragonslayer has an antibiotic protocol that he shares if you email him, and I have no doubt that he'll have some pointers for you.
As for timing probiotics, I'm not sure. You certainly want to make sure that when the antibiotics are finished that you're repopulating the gut with good beasties.... and you can get the trots as a result of antibiotics as your gut flora does play a big role in digestion and you're wiping out the good and the bad... So, maybe starting them while on the antibiotics and keeping on going with them after...? Someone might have a better idea than me. Oh... and double check what is in with the pro-biotics, as I did have a bit of a job tracking down some that were starch free... if in doubt get that iodine out.
As for fasting, it really can make such a big difference. When I was preparing for an endoscopy while on anti-inflamms I knew that I wouldn't be able to take them without solid food, and my biggest worry was not being able to move due to pain. I made sure that I had some kids liquid stuff I could take, just in case. However, I didn't need to use it at all. Perhaps he could talk to his doctor about it, if he is contemplating it but has concerns.

The only other thing I can think of... is there any chance that there is some starch sneaking in still? Might be worth double checking...

Glad that the doctor is willing to work with you, and is open to different approaches. Hopefully you can work out what is giving the improvements, and keep them going!

Hi, Emily:

I think that DavidP got it right, but I don't have any direct experience with Augmentin. Flagyl would be a very good thing to follow up with, also as it not only keeps the Clostridium down to prevent the bad colitis potential, but also has some anti-Klebsiella effects, and one of the causes of AS is exposure to the waterborne protista Giardia and these can be partially dormant for many years even.

The BIG CAUTION is to remain starch-free while on the antibiotics. Some people have found that antibiotics help reduce AS symptoms but ignored diet and after a year or so developed resistive colonies. To make sure these agents continue to work, it is important to keep with a strict diet.

Also, taking the NSAID is not a good thing, but counter-productive to resolving AS. I HATE to recommend other NSAIDs but as a minimum he should be off the non-selective variety!

It was FOUR DAYS for me--taking antibiotics during strict NSD DRAMATICALLY eliminated my symptoms after only four days and that is after several months of spotty results on diet alone.

Hope that he continues to improve and can ditch the NSAIDs for some real gut healing.

HEALTH,
John

It is great to have such knowledgable people around here....

Thank you so much for you help. I always appreciate your time.
I will ask the Dr for Flagyl today, do you think my hubby should try another type of antibiotic after he has finished the Augmentin? Or maybe give it a rest for a month.

Yes, we are always trying to be strict on the NSD- hopefully a change for his lifetime.

That is also helpful to know the timeframe for your improvements from Antibiotics.

What are the non-selective NSAIDS?

Kind regards, and thank you so much for the help. One Dr appointment costs $125 so to get expert advice from yourself, David and Kurumi for free is so fantastic.

HI David,

Thank you so much for your help and knowledge. We had originally visited this Dr to get an LDN perscription and then he asked us if we had tried an exclusion diet. Anyway when I suggested antibiotics he asked me which one to try and I hadn't come prepared at all so I had no clue either. So that is really helpful with the info about Augmentin and Flagyl- do think he only needs the Flagyl if he develops diarrohea?

A million thank yous

Kind regards,

Emily

I agree- knowledge and wisdom from everyone here and willingness to share time and experiences.

Hi,

Thanks, really helpful info thanks. Very interesting about the anti-inflamms and fasting. What did you mean by the liquid kids stuff? is there a childs version of NSAIDS??

I want my hubby to fast and stop NSAIDS but i cant make him do it. he always follows what the Dr says- that is why i was so happy when his Dr mentioned the exclusion diet before I did. He's very strong and would have the courage but he trusts the Rheumy who really hasnt helped much. I put my faith in God and KA.

Thanks again

Emily

Emily:



Not in that order, I hope... =( ;--)) Just kidding!

A good antibiotic for maintenance between Cipro doses is tetracycline: 500mg just before each of three largest meals really helps. About 1500-2000mg daily but certainly check with the physician. I have taken as much as 3500mg in a day, but prefer none at all of course (fasting is good for this).

Non-selective NSAIDs suppress both COxI and COxII levels. The newer, selective agents (Vioxx and Celebrex) seem to be less dangerous (fewer people dying from spontaneous bleeding ulcers) and perhaps do have some intestine-protecting capacity by mostly suppressing COxII. As we have found out, there are other dangers (Vioxx has been pulled from the market), but I think these are more dramatic but fewer in number, so it is a choice that should be an informed one. I would prefer to NEVER recommend any NSAID--they are so much more dangerous than antibiotics (which are, admittedly dangerous and should not be taken without some warnings--and actually tetracycline once caused all of a woman's skin to peel off--including from her eyeballs! She lived, but it was very scary and certainly a very very rare thing, but these are risks we all must be aware of...).

We stick with diet which has almost no risk, and find some EFAs (at least 11g daily--find borage seed oil and take EVOliveOil and of course fish oils) instead of NSAIDs.

Hope he continues to improve,
John

Hi Emily,
Both the antifungal and the flagyl could be considered precautionary, so some people would probably go without them and hope for the best. Dragon Slayer is right that Flagyl is also an anti-parasitic agent so will act against Giardia lamblia, which is by far the most common parasite we are likely to see.

As an aside - Candida as a source of gut problems is debateable. Some people only report it if the fruiting hyphae are present in the faeces along with the single Candida cells. Candida is present in many asymptomatic patients. I seem to react badly to sugars but have never seen any Candida in my faeces. I'm sure that many people are diagnosed with Candida without any direct proof from faecal examinations.

This discussion is timely for me since I'm going to try antibiotics soon. After 2 years on a LSD / NSD I still have a lot of gut problems and some inflamed joints. When my faeces are firm I can't grow any Klebsiella. But if I culture my stools when they are loose I usually pick up a few colonies of Klebsiella on the selective media we use (called MacConkey's Agar). Klebsiella is a bacteria which often has a slimy capsule - perhaps these strains are harder to get rid off. Some strains can be resistant to quite a few antibiotics. It's worth noting that as far as a microbiology lab is concerned that Klebsiella is considered part of the normal bowel flora.
The lab is really only looking for the bacteria Salmonella Shigella Campylobacter and Yersinia (and a few others) and also parasites like Giardia and Cryptosporidium.

Regards David P

Hi Emily,

A few years ago Jon did really really well on low dose doxycyline (100mg on Mon, Wed and Fri each week). This is a member of the tetracycline family of antibiotics. Based on www.roadback.org protocol.

You may find this link helpful:
Rheumatic.org

So I would recommend it. After 3 months however, Jon developed a really bad stomach problem. Every time he ate anything sugary he got severe stabbing pains in his stomach. So he had to stop the antibiotics and go on an anti-candida diet and it took him over 6 months to come right again.

So use antibiotics at your peril! If taking them then Len should limit or preferably exclude white sugar and also take probiotics....homemade sauerkraut is best.

Chelsea

By that I meant kids liquid pain relief, the kind of stuff that you'll already have on hand for your wee ones fevers etc... Palmol? They will have either sugar or artificial sweetner in them. You'd want to go with a natural sweetner, as artificial ones are to be avoided... My understanding is that paracetamol is still a NSAID, but it isn't heavy duty like the Naproxen.

I got this as an emergency measure, as having to skip my meds while on a day of fluids had me concerned about whether or not I'd be able to get up at all the next day, based on a previous experience of a skipped pill. I had learnt the hard way that if I didn't take my NSAID with food it would completely clear my digestive system out over the next half day or so with what felt like a steel wool scourer. Not something I ever want to experience again. However, I was surprised that I didn't have a great deal of pain, and I didn't need any pain relief at all. I should have paid more attention to that experience, and wish I'd done more research and got off the NSAIDs as soon as possible. They can cause problems later on, even if they seem fine at the time. While it is important to get pain under control, I am really against the nonselelctive NSAIDs as a long term med. There are just too many risks, in my opinion. Especially if you're not on anything to help protect your stomach. If your hubby isn't and is continuing to take them, I recommend that this is something you discuss with the doctor to get, even if it doesn't seem like it is causing problems now. I am suspicious of some of the problems I have had this year, and can't help but suspect the NSAIDs... They really are evil. Although, they were making the difference of being able to get up in the morning and semi-function before I got my diagnosis.

I never thought a fast would be something I could do, as I hate being hungry and have had trouble in the past with low blood sugar. However, the NSD has evened the blood sugar out and isn't normally a problem at all now. Would he be willing to try a day of apples or grapes and juice? That would be a way of starting gently...

Hello Dear John!
My name is Ruslan. I am 31.
I have pain in my back more than 10 years, but only last year the diagnosis has been made.
It is AS.
Last years backbone deformation has begun. In pictures it has been revealed
that I have crisis of 6 vertebras, which makes me a strong pain.
As well the diagnosis an osteoporosis has been made. My treating doctor-rheumatologist has appointed treatment of Sulfasalasin and new medicament BonViva.
Sulfasalasin I accept in a current of 3 months and have made 1 injection BonViva
and I accept a lot of Calicium + D 3 on the doctors prescription.
But I do not feel better. Last week I has found your site and I am very delighted. I have read about a diet without starch and began to adhere to it. Now I feel small improvement. As I have read, you help to people, sending the list of antibiotics for treatment of my disease. I want to ask you send me such list and all your recommendations.
Please, send it on email nmarynich@no.spam.yahoo.com.
I wish to specify, whether correctly my doctors treatment?
Whether it is necessary for me to accept Sulfasalasin? I have read that at it has many by-effects.
Whether it is necessary for me to accept injection BonViva, what do you know about it?
I hope for your help.
Sincerely,
Ruslan.

Naproxen is available (by prescription in the US) in a liquid suspension form, as is Mobic. Various liquid forms of Ibuprofen are also available (over the counter). They are commonly used in Juvenile Arthritis.