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EDITORIALS: Kathleen B Digre Not so benign intracranial hypertension BMJ 2003; 326: 613-614 [Full text]

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Doxycycline Induced Intracranial Hypertension In Africa : The drug , the diseases and the doctor

Bello S Oricha, Muhammad B Y   (24 March 2003)

Adverse Reactions to Doxycycline, Minocycline, are often Jarisch-Herxheimer Reaction

Trevor G Marshall, PhD   (25 March 2003)

Doxycycline Induced Intracranial Hypertension In Africa : The drug , the diseases and the doctor 24 March 2003
Bello S Oricha, Associate Lecturer Department Of pharmacology, Usmanu Danfodiyo University, C/O P.O.Box 1522, Sokoto, Muhammad B Y Send response to journal: Re: Doxycycline Induced Intracranial Hypertension In Africa : The drug , the diseases and the doctor	Doxycycline is an attractive medication in Africa. At 0.04 Pounds per capsule, it is quite tempting to prescribe this antibiotic in deserving clinical situations including pelvic inflammatory diseases(PID) and malaria. These diseases are quite common in Africa and the paucity of diagnostic aid options in all levels of practice make empirical treatment often the only option. Moreover, malaria may be associated with clinical sign and symptoms of Intracranial hypertension(IH)(1)while PID patients commonly present with infertility(2). The increasing incidence of depression, binge eating disorders and the trifty gene question may have contributed to an increasing number of PID patients with infertility also with the weight status of obesity(3). The diagnostic quagmire above makes near patient decisions difficult and quite risky. Do you include doxycycline in the regimen in a patient who most likely have multidrug resistant plasmodium malaria or not? This patient is also very likely not to comply with follow up request irrespective of treatment outcome, previous drug history is often not available or unreliable. Is the doxycycline the patient likely to buy of good quality? Is there any data on the prevalence of idiopathic or incidence of secondary IH in populations extrapolatable to the patient?(4). Imagine the dilemma if up to 30 of such patients are seen daily by a doctor with an average patient load of 200 per day and is underpaid but has to meet the demands of an extended family. We have the fortune of running a private hospital and have seen about 15 cases that may be classed as secondary IH due to doxycycline. All developed severe headache within 6 days of 100mg bd doxycyline, discontinued the drug and represented; most likely because Physician- patient relationships are better established in private hospitals (?fewer patients and better rewards). The big picture is that the bottleneck of diseases in Africa is worsened by redundant signs and symptoms of adverse drug reactions. It may be argued that Practice in Africa is probably a "specialization" event where the history and examination is often what is available for decisions and the 'art' of medicne is placed before the science. Sir Robert Hutchison might have been proud of the results(5). References 1.Schutta HS, Corbett JJ. Intracranial hypertension syndromes. In Joynt R, Griggs R, ed. Baker’s clinical neurology. Baltimore: Lippincott, Williams and Wilkins, 1997:1-57. 2.Buchan H, Vessey M, Goldacre M, Fairweather J. Morbidity following pelvic inflammatory disease. Br J Obstet Gynaecol 1993; 100: 558-562 3.Wilding J. Science,Medicine, and the Future: Obesity treatment BMJ 1997;315:997-1000 4. Wolffers I, Adjei S, Drift R. Health research in the tropics. Lancet 1998; 351: 1652-1654 5. Swash M, Sir robert Hutchison. In Hutchison's Clinical Methods 21st Edition 2002: preface to the 21st edition. Competing interests:   None declared
Adverse Reactions to Doxycycline, Minocycline, are often Jarisch-Herxheimer Reaction 25 March 2003
Trevor G Marshall, PhD, Research Director Sarcinfo, Thousand Oaks, California, 91360 Send response to journal: Re: Adverse Reactions to Doxycycline, Minocycline, are often Jarisch-Herxheimer Reaction	Adverse reactions to Doxycycline, Minocycline and Tetracycline should initially be investigated as possible Jarisch-Herxheimer Shock. These three antibiotics are very effective against the Cell Wall Deficient forms of bacteria that are behind much immune disease [1]. Even "Minocycline Induced Lupus" should be initially investigated as herxheimer, especially lacking any biochemistry that could explain the suspected "Adverse Reaction". With herxheimer it can be expected that the patient will 'recover' when the antibiotic is withdrawn, and regress when rechallenged. I wrote a 'Rapid Response' yesterday [2] explaining 'undiagnosed immune disease', and reporting the new assays for measuring D-Ratio and 1,25-dihydroxyvitamin (1,25-D) [3], the best way I know of detecting immune dysfunction. We have observed abnormal production of 1,25-D in a large proportion (20% to 50%) of a cohort of Euthyroid patients and also in our own cohorts of patients with serious immune disease. A Jarisch-Herxheimer reaction causes the level of circulating 1,25-D to rise. An elevated level of 1,25-D should lower the systemic Blood Pressure (BP), but it does not do this in patients with immune dysfunction. Excess 1,25-D causes their BP to rise, and become unstable. It also gives psychotic symptoms such as paranoia, paresthesia, aggressiveness and depression, along with uncontrollable migraines. 1. Mattman L: Cell Wall Deficient Forms: Stealth Pathogens. 2nd Edition: CRC Press; 1992, ISBN 0849344050 2. Marshall TG, Marshall FE: Biochemists already know how Bacteria induce Thyroid Dysfunction. [Rapid Response] BMJ 2003; 27 Mar. Available from URL http://bmj.com/cgi/eletters/326/7384/295#30665, Accessed 23 Mar 2003. 3. Marshall TG, Marshall FE: The Science Points to Angiotensin II and 1,25-Dihydroxyvitamin D. [Electronic Letter] Chest 2003; 6 Feb. Available from URL http://www.chestjournal.org/cgi/eletters/123/1/18#95, Accessed 23 Mar 2003. Competing interests:   None declared