Investigating the efficacy of antiviral and antibiotic therapy

Going beyond anecdotal evidence for use of antiviral or antibiotic treatments, several research papers at the Ottawa conference reviewed positive responses to antiviral therapy and antibiotic therapy in CFS—in particular, for those patients who had high antibodies to enteroviruses or in CFS precipitated by the Epstein Barr Virus (EBV).

Dr. Jose Montoya (at the Stanford School of Medicine, Palo Alto, CA) has been studying an antiviral regimen which he has developed for treatment of ME/CFS, but the actual protocol has had limited circulation. Dr. Montoya has agreed to prepare a paragraph for inclusion in the IACFS/ME Physician's Primer which suggests that an approach and rationale could (and perhaps, should) be developed for the use of particular agents for ME/CFS patients who demonstrate particular viral loads.

The efficacy of treatments with antivirals or antibiotics needs to be further investigated. It also needs to be determined what would prompt a well-planned, carefully executed clinical trial.

A study showing positive response to antibiotic treatment in ME/CFS was presented by Dr. Sam Shor, from the Washington, D.C. area. Dr. Shor placed his ME/CFS patients on the same treatment regimen—a combination of multiple, long-term antibiotics—which he used for his chronic Lyme Disease patients. Patients with ME/CFS met the international case definition and were negative for Lyme Disease (LD).

Improvement of symptoms was found in 66% of ME/CFS patients even though they were seronegative for LD. Several possible interpretations of these results, according to Dr. Friedman, would be: 1) the possibility of these CFS patients having LD, 2) viewing the improvements as potentially due to the immunomodulatory effects of the antibiotics, or 3) an infection that could be at the root of their CFS was responding to the treatment.

Similarly, a Norwegian study discovered that a cancer agent, rituximab, had reduced symptoms of CFS, raising the same questions with regard to that drug's immunomodulatory effects. Dr. Friedman explained these agents work on the same system (the immune system) and felt that research of drugs with these particular properties would be worthwhile for ME/CFS.