How is Whipple disease best treated?
- Initial treatment is ceftriaxone (or meropenem) for 2 weeks to ensure therapy of the CNS. Oral trimethoprim (TMP)–sulfamethoxazole (SMX) is subsequently used for more than 1 year.
- Tetracycline can be used in sulfa-allergic patients.
- Relapses can occur particularly in patients with CNS involvement (30%).
- These patients should be treated indefinitely with oral TMP/SMX.