Antibiotic improves outcome following acute stroke
Original article
Lampl Y et al. (2007) Minocycline treatment in acute stroke: an open-label, evaluator-blinded study. Neurology 69: 1404–1410 PubMed
Minocycline, a tetracycline antibiotic proven safe in various human applications, has been shown to have a neuroprotective effect in animal models of stroke. The mechanism responsible is thought not to be antibiotic activity, but rather anti-inflammatory processes and inhibition of apoptosis. In a randomized open-label study of 152 patients, Lampl et al. have demonstrated that administration of minocycline 6–24 h after symptom onset can improve clinical outcomes following acute ischemic stroke.
Patients presenting too late to receive standard thrombolytic therapy were randomized to receive minocycline 200 mg (n = 74) or placebo (n = 77) orally for 5 consecutive days. Neurological and functional deficits were assessed by an evaluator blinded to treatment. Significantly better outcomes were seen in the treatment group than in the placebo group from as early as day 7, and continuing to the end of follow-up (day 90), as measured by NIH Stroke Scale (NIHSS), modified Rankin Scale and Barthel Index scores (P <0.001). At the end of follow-up, NIHSS scores were significantly lower in the treatment group than in the placebo group (1.6 
1.9 vs 6.5 3.8; P <0.0001), and the rate of adverse effects did not differ between the two groups. The authors hypothesize that the rapid treatment effect is attributable to the simultaneous induction of various mechanisms of action of minocycline.
The results of this study are promising, but the neuroprotective potential of minocycline for patients with acute ischemic stroke needs to be confirmed in a large, double-blind trial.
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Subject areas under which this article appears: Stroke