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Antibiotics for Rheumatologic Diseases: A Critical Review
Matthew E Falagas1,2,3, Panagiotis Stathopoulos1, Dimitrios S Kontogiannis1
1Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, Marousi, 151 23 Athens, Greece.
International Journal of Molecular Sciences
|November 13, 2025
Summary
Antibiotics may help some rheumatologic diseases with clear infections, like rheumatic fever or Lyme disease. Their use in other autoimmune conditions requires more research before widespread adoption.
Area of Science:
- Rheumatology
- Immunology
- Pharmacology
Background:
- Antibiotics traditionally treat infections but possess immunomodulating properties.
- Emerging literature explores antibiotic use in rheumatologic diseases, often autoimmune-driven.
- Review focuses on antimicrobial and immunomodulatory effects in rheumatology.
Purpose of the Study:
- Critically review antibiotic use in rheumatology.
- Examine antimicrobial actions and immunomodulatory effects.
- Evaluate clinical applications, mechanisms, controversies, and future research.
Main Methods:
- Comprehensive literature search of major biomedical databases (PubMed, Scopus, Web of Science, Cochrane) and Google Scholar.
- Critical evaluation of existing data on antibiotic use in rheumatologic conditions.
- Analysis of antimicrobial and immunomodulatory mechanisms.
Main Results:
- Antibiotics are indicated for rheumatologic diseases with clear infectious etiology: rheumatic fever, Whipple's disease, early Lyme disease.
- Early antibiotic administration may benefit reactive arthritis.
- Current evidence does not support antibiotic use in non-infectious rheumatologic diseases.
Conclusions:
- Antibiotic use in rheumatology should be limited to conditions with proven infectious origins.
- Further robust clinical trials are necessary to explore antibiotic efficacy in other rheumatologic diseases.
- Adherence to current guidelines is recommended for non-infectious rheumatologic conditions.
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