How Antibiotics May Interact with Multiple Sclerosis Disease-Modifying Therapies

How Antibiotics May Impact People with Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. It can cause disabling symptoms like fatigue, mobility problems, and pain. While there is no cure yet for MS, various medications can slow disease progression and manage symptoms.

People with MS may need to take antibiotics for bacterial infections the same as anyone else. But antibiotics can interact with MS disease-modifying therapies and possibly influence the course of the disease itself. Understanding the link between antibiotics and MS is important.

MS Disease-Modifying Therapies

Several types of medications for MS work to modify the disease course and prevent relapses. These disease-modifying therapies (DMTs) reduce inflammation and immune system attacks on the nervous system. Examples include:

• Interferons like Avonex, Rebif, Plegridy
• Monoclonal antibodies such as Ocrevus, Rituxan
• Spingosine analogs including Gilenya
• Immunosuppressants like Tysabri

People taking DMTs need to be aware of potential interactions with antibiotics and other medications. The altered immune response caused by antibiotics can decrease effectiveness of MS therapy. Always inform your doctor about any new medications you start.

Antibiotics May Lower DMT Efficacy

Research indicates that taking certain antibiotics while on MS disease-modifying treatment could hamper the benefits. Some analyses have found:

• Greater MS disease activity after antibiotic use
• More than double the risk of MS relapse
• 6 times higher chance of new brain lesions

Experts theorize that antibiotics disrupt the natural gut microbiome. This impairs the immune system regulation that DMTs rely on to work properly. Antibiotics may also directly alter drug metabolism.

The Impact Varies by Antibiotic Class

Not all antibiotics seem to interact with MS therapies the same way. Research points to greater MS disease activity from these types in particular:

• Fluoroquinolones like Ciprofloxacin
• Cephalosporins like Keflex
• Penicillins like Amoxicillin

On the other hand, two other common antibiotic classes appear safer for MS patients on DMTs:

• Macrolides such as Azithromycin
• Tetracyclines like Doxycycline

Doctors may recommend these lower-risk antibiotics when possible for people with MS. Talk to your neurologist about the best antibiotic choice for your situation if needed.

Weighing Infection Risk vs. MS Progression

Infections in people with MS can also directly worsen symptoms. So avoiding or improperly treating infections is not advisable either.

Work closely with your doctors to balance infection control with MS disease management if antibiotics are needed. Some strategies may include:

• Choosing narrow-spectrum antibiotics when possible
• Using the lowest effective antibiotic dose
• Monitoring closely for return of MS symptoms
• Considering preventive probiotic use

Your doctors can help determine if antibiotics are absolutely necessary, and if so, guide the best protocol for your situation.

Some Antibiotics Appear Safer for MS Patients

The impact of antibiotics on MS disease activity seems to depend somewhat on which types are used. Here is more about the safety profiles of certain classes:

Penicillins

Common penicillin derivatives like Amoxicillin are associated with higher MS relapses when taken by people on DMTs. The weakened immune regulation can allow inflammation and nerve damage to increase.

Cephalosporins

This broad-spectrum antibiotic class may also disrupt immune homeostasis in the gut microbiome. In turn, this appears to reduce stability in people with MS taking DMTs and increase complications.

Fluoroquinolones

Ciprofloxacin and other fluoroquinolones directly impact immune cell function. They may stimulate inflammation and disease progression. Use requires careful consideration in MS patients.

Macrolides

Azithromycin and similar macrolide antibiotics do not appear to provoke MS disease activity or reduce DMT benefits to the same degree. This class may be a safer option when antibiotics are needed.

Tetracyclines

Evidence also suggests tetracyclines like Doxycycline have minimal negative impact on MS. They may change gut microbiome composition less than other antibiotic classes.

Discuss antibiotic options for your condition with your neurologist and other doctors. Certain classes appear preferable in MS patients on DMTs when possible.

Added MS Risks with Repeated Antibiotic Use

Recurrent antibiotic use over time may compound risks for people with MS beyond individual interactions. Possible concerns include:

• Cumulative loss of microbiome diversity
• Increasing antibiotic resistance for future infections
• Higher vulnerability to opportunistic pathogens like C. difficile
• Greater chance of antibiotic allergic reactions
• Potential long-term effects on immune function

Try to avoid unnecessary antibiotic use. But if you develop infections frequently, work with your doctor to explore possible underlying causes. Treating predisposing factors may reduce recurrence of infections requiring antibiotics.

Watching for Signs of an MS Relapse

Patients on DMTs should monitor for possible MS relapse signs and symptoms within one to three months after taking antibiotics. Concerning relapse red flags include:

• Numbness, tingling or pain
• Weakness in arms or legs
• Blurry or double vision
• Dizziness or vertigo
• Poor coordination or imbalance
• Cognitive changes like memory issues
• Bladder control difficulties
• Severe fatigue, depression or anxiety

Notify your neurologist right away if your MS symptoms flare up significantly after recently taking antibiotics. You may need medication adjustments or other interventions to stabilize your condition again.

Probiotic Use with Antibiotics in MS Patients

Taking probiotic supplements during and after antibiotics may potentially help avoid some disruptions to gut microbiome balance. Research in MS patients taking antibiotics shows:

• Lower systemic immune activation with probiotics
• Reduced inflammatory markers
• Possible increased regulatory T cells, which suppress autoimmunity

More study is still needed on ideal strains and dosing. Talk to your doctors about incorporating probiotics alongside antibiotics to help mitigate risks.

Special Concerns with Steroid Use for MS

Steroid drugs like Prednisone are sometimes used short-term to treat acute MS attacks and relapses. But steroids significantly lower immune response, with added infection risks.

Taking antibiotics and steroids together requires caution. Your doctor will attempt to balance controlling the current MS flare versus weakening your body's ability to fight the infection being treated.

Closely monitor your health if taking both steroids and antibiotics for MS-related reasons. Report any concerns or new symptoms promptly.

Seeking Advice from Your MS Healthcare Team

If your doctor recommends antibiotics for an infection, be sure to ask about any MS-related considerations, such as:

• Interactions with your DMT medication
• Which antibiotic class may be safest for you
• Need for probiotics during treatment
• Steps to take if your MS worsens
• Precautions with immunosuppressant steroids

Your neurologist, primary care provider and pharmacist can help determine the best protocol to balance treating the acute infection with avoiding MS disease progression when possible.

Weighing the Benefits and Risks of Antibiotics with MS

Antibiotics remain an important tool for controlling infections, which could themselves exacerbate MS. But their use does require caution and monitoring in people whose immune systems are already compromised.

Work as an engaged patient with your healthcare team. Ask questions, report any new or concerning symptoms, and consider preventive steps like probiotics. Staying informed and proactive will provide the best protection.

With proper oversight and management, short-term antibiotic use can be undertaken safely during active MS disease-modifying therapy in many cases. Stay in touch with your providers for optimal outcomes.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.