**Before we quote this paper below please note that criteria for PANS and PANDAS are useful but not each child fits these criteria exactly.
The authors write: :There is only one published randomized, double-blind, placebo–control study that has examined the use of antibiotic therapy in youth satisfying PANDAS/ PANS criteria (32). [And hundreds of clinicians have used antibiotics on thousands of children]. In emerging science it is useful to have anything with a placebo part in which patients and doctors know nothing about the treatment. The glass is half full.
[And if PANS or PANDAS has 10 criteria we should not expect all criteria will be cured in even six months by one treatment. For example most of my PANS and PANDAS patients have autoimmunity against their neurons AND misc complex infections].
QUOTES
In this study, 31 children meeting PANS criteria with acute-onset or relapse of moderate-severe OCD symptoms within 6 months were randomized to receive azithromycin or placebo for 4 weeks. [What were they treating? Azithromycin does not kill everything we find in PANS/PANDAS PATIENTS].
A greater reduction in the Clinical Global Impression-Severity Scale (CGI-S) for OCD symptoms was seen in the azithromycin group compared to the placebo group.
However, other neuropsychiatric outcomes did not differ between the intervention and placebo groups.
1. I have never seen one treatment cure PANS/PANDAS.
2. We have used much higher azithromycin doses [See Schaller. Babesia 2009 Update].
3. Why four weeks’ treatment? This assumes very rapid growing infections. Some PANS and PANDAS patients have very slow growing infections. All doctors, including me, never think of YB with three medications for two years. We think of fast rabbit reproducing infections that are killed with antibiotics in 5-7 days.
4. Will this kill all PANS/PANDAS bacteria and the diverse forms of these infections?
5. Will azithromycin 500mg drive through tough thick biofilm slime protective coatings of most bacteria? [See: Combating Biofilms. Schaller. 2014].
6. Long-term penicillin prophylaxis …. in a randomized double-blind, placebo-controlled, cross-over trial (n=37) (33) [helped depression and anxiety scale ratings [and… many] parents identified improvement in behaviour [with treatment] … compared to placebo.
7. A second small non-placebo-controlled double-blind study randomized 23 children with PANDAS to azithromycin or penicillin for 12 months (34).
Both groups had a significant reduction in GAS infections compared to the previous year (96% reduction overall), along with a 61% reduction in frequency of neuropsychiatric
symptom exacerbations. [There was no untreated group to compare, but this is what many of us see clinically with these treatments].
Wilbur C, Bitnun A, Kronenberg S, Laxer RM, Levy DM, Logan WJ, Shouldice M, Yeh EA. PANDAS/PANS in childhood: Controversies and evidence. Paediatr Child Health. 2019 May;24(2):85-91. doi: 10.1093/pch/pxy145. Epub 2018 Dec 9. PMID: 30996598; PMCID: PMC6462125.