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==Overview==
==Overview==

Revision as of 20:29, 7 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Antimicrobial therapy is the mainstay of therapy for Whipple's disease. Without antibiotic therapy Whipple's disease is fatal. Intravenous Ceftriaxone or Penicillin G is indicated in the acute phase of Whipple's therapy. For maintenance therapy, patients are typically treated with Trimethoprim-sulfamethoxazole for at least 1 year. Patients who experience either Whipple's disease or allergy to Trimethoprim-sulfamethoxazole require a combination of Doxycycline and Hydroxychloroquine.

Medical Therapy

  • 1 Classic Whipple's disease
    • 1.1 Initial therapy
      • 1.1.1 Preferred regimen (1): Ceftriaxone 2 g IV qd for 14 days
      • 1.1.2 Preferred regimen (2): Penicillin G 2 million units IV q4h for 14 days
      • 1.1.3 Alternative regimen (1): Meropenem 1 g IV q8h for 14 days
    • 1.2 Maintenance therapy
  • 2 CNS infection
    • 2.1 Initial therapy
      • 2.1.1 Preferred regimen (1): Ceftriaxone 2 g IV qd for 14-28 days
      • 2.1.2 Preferred regimen (2): Penicillin G 4 million units IV q4h for 14-28 days
      • 2.1.3 Alternative regimen (1): Meropenem 1 g IV q8h for 14-28 days
    • 2.2 Maintenance therapy
    • 2.3 Anticonvulsant therapy
      • 2.3.1 Preferred regimen (1):
      • 2.3.2 Preferred regimen (2):
  • 3 Endocarditis
    • 3.1 Initial therapy
      • 3.1.1 Preferred regimen (1): Penicillin G 2 million units IV q4h for 28 days
        • 3.1.2 Preferred regimen (2): Ceftriaxone 2 g IV qd for 28 days
        • 3.1.3 Alternative regimen (1): Meropenem 1 g IV q8h for 28 days
    • 3.2 Maintenance therapy
  • 4 Relapse
    • 4.1 Initial therapy
      • 4.1.1 Preferred regimen (1): Penicillin G 4 million units IV q4h for 28 days
      • 4.1.2 Preferred regimen (2): Ceftriaxone 2 g IV qd for 28 days
    • 4.2 Maintenance therapy

Note (1):

Indication Initial therapy Maintenance therapy
Prefered Alternative Preferred Alternative
Classic Whipple's disease Ceftriaxone 2 g IV qd for 14 days

OR

Penicillin G 2 million units IV q4h for 14 days

Meropenem 1 g IV q8h for 14 days Trimethoprim-sulfamethoxazole one DS tablet (160 mg TMP/800 mg SMX) PO q12h for 1 year Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year
CNS Whippl'es disease Ceftriaxone 2 g IV qd for 14-28 days

OR

Penicillin G 4 million units IV q4h for 14-28 days

Meropenem 1 g IV q8h for 14-28 days Trimethoprim-sulfamethoxazole one DS tablet (160 mg TMP/800 mg SMX) PO q12h for 1 year Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year
Endocarditis Penicillin G 2 million units IV q4h for 28 days

OR

Ceftriaxone 2 g IV qd for 28 days

Meropenem 1 g IV q8h for 28 days Trimethoprim-sulfamethoxazole one DS tablet (160 mg TMP/800 mg SMX) PO q12h for 1 year Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year
Relapse Penicillin G 4 million units IV q4h for 28 days

OR

Ceftriaxone 2 g IV qd for 28 days

Doxycycline 100 mg PO q12h AND hydroxychloroquine 200 mg PO q8h for 1 year Trimethoprim-sulfamethoxazole one DS tablet (160 mg TMP/800 mg SMX) PO q12h for 1 year

References

  1. Feurle, Gerhard E.; Junga, Natascha S.; Marth, Thomas (2010). "Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple's Disease". Gastroenterology. 138 (2): 478–486. doi:10.1053/j.gastro.2009.10.041. ISSN 0016-5085.
  2. Durand DV, Lecomte C, Cathébras P, Rousset H, Godeau P (1997). "Whipple disease. Clinical review of 52 cases. The SNFMI Research Group on Whipple Disease. Société Nationale Française de Médecine Interne". Medicine (Baltimore). 76 (3): 170–84. PMID 9193452.
  3. Schnider, P. J.; Reisinger, E. C.; Berger, T.; Krejs, G. J.; Auff, E. (1997). "Treatment guidelines in central nervous system Whipple's disease". Annals of Neurology. 41 (4): 561–562. doi:10.1002/ana.410410425. ISSN 0364-5134.
  4. Boulos A, Rolain JM, Raoult D (2004). "Antibiotic susceptibility of Tropheryma whipplei in MRC5 cells". Antimicrob. Agents Chemother. 48 (3): 747–52. PMC 353111. PMID 14982759.
  5. Feurle GE, Marth T (1994). "An evaluation of antimicrobial treatment for Whipple's Disease. Tetracycline versus trimethoprim-sulfamethoxazole". Dig. Dis. Sci. 39 (8): 1642–8. PMID 7519538.
  6. Keinath RD, Merrell DE, Vlietstra R, Dobbins WO (1985). "Antibiotic treatment and relapse in Whipple's disease. Long-term follow-up of 88 patients". Gastroenterology. 88 (6): 1867–73. PMID 2581843.


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