An Antibiotic to Treat Stroke?

Robert W. Griffith, MD

Minocycline is a tetracycline antibiotic that has a broad spectrum of activity against bacteria. However, animal studies have shown that it may have a neuroprotective action, too (this means it may protect nerve cells from damage). A study done in Israel, and reported in the journal Neurology, has now shown that this neuroprotective action can be of use in the management of stroke in the early stages.

A pilot study of 150 acute stroke patients were given 200 mg of minocycline daily for 5 days, or placebo, within 6 to 24 hours of the onset of symptoms. Various scales were used to evaluate the patients' course, the main one being the National Institutes of Health Stroke Scale (NIHSS). Significant differences in favor of minocycline treatment were seen after 7, 30, and 90 days. At 90 days the minocycline group had an average NIHSS score of 1.6, indicating little or no disability, compared with 6.5 for the placebo group, which is near the upper limit for mild disability.

In contrast to these signs, there were no differences between minocycline and placebo with respect to mortality, heart attack, recurrent stroke, or hemorrhagic transformations during follow-up. ( Hemorrhagic transformation is a dangerous possibility during therapy designed to dissolve a thrombus.) But there were no side effects of minocycline.

The investigators and other experts conclude that a large-scale study will be needed to prove the effectiveness of minocycline used in this way. Other agents with apparent neuroprotective actions in the laboratory have failed, clinically. But I'm optimistic that minocycline (or another closely related drug) will provide what's needed - something that extends the present "window" for effective treatment from 1 to 3 hours up to 24 hours.

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