How is Whipples disease treated

How is Whipples disease treated

Before the use of antibiotics, Whipple’s disease was uniformly fatal. Though antibiotic treatment of T. whipplei often leads to a rapid improvement of symptoms (typically within 1–2 weeks), prolonged treatment is required to ensure eradication of the bacterium. Additionally, there is no widely accepted method of noninvasive monitoring. Although there is no general consensus on the best antibiotic regimen, the following has been recommended:

  • • Classic Whipple’s disease without neurologic involvement:
    • Induction: Ceftriaxone 2 g intravenous (IV) once daily or Penicillin G 2 million units (MU) IV every 4 hours for 14 days. If allergic to ceftriaxone/penicillin, use meropenem 1 g IV every 8 hours for 14 days.
    • Maintenance: follow induction antibiotics with one double-strength trimethoprim/sulfamethoxazole (TMP/sulfa) 160 mg/800 mg orally twice daily for 1 year. If allergic to sulfa, use doxycycline 100 mg twice daily plus hydroxychloroquine 200 mg thrice daily orally for 1 year.
  • • Whipple’s disease with neurologic symptoms and/or a positive PCR in CSF in an asymptomatic patient:
    • Induction: Ceftriaxone 2 g IV once or twice daily or Penicillin G 4 MU IV every 4 hours for 14–28 days. Consider using the higher doses for the longer period of time (i.e., 28 days) in patients with overt neurologic symptoms.
    • Maintenance: same as classic Whipple’s disease
  • • Whipple’s disease with endocarditis
    • Induction: Ceftriaxone 2 g IV once daily or Penicillin G 2 MU IV every 4 hours for 28 days.
    • Maintenance: same as classic Whipple’s disease
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