Tropical sprue medical therapy: Difference between revisions
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{{Tropical sprue}} | {{Tropical sprue}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{AKI}} | ||
==Overview== | ==Overview== | ||
[[Folic acid]] and antimicrobial therapy are the mainstay of treatment for [[tropical sprue]]. Supportive therapy includes adequate [[hydration]] and replacement of nutrients such as [[iron]] and [[vitamin B12]]. Oral [[Tetracycline]] is contraindicated among [[pregnant]] and lactating women and among children < 8 years of age. The main aims of treatment include: control of [[diarrhea]], correction of existing [[vitamin]] deficiencies and cure of the disease. | |||
Oral | |||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for [[tropical sprue]] includes [[antibiotics]] and [[folate]] supplementation.<ref>{{Cite journal| issn = 0003-4819| volume = 63| issue = 4| pages = 619–634| last1 = Guerra| first1 = R.| last2 = Wheby| first2 = M. S.| last3 = Bayless| first3 = T. M.| title = Long-term antibiotic therapy in tropical sprue| journal = Annals of Internal Medicine| date = 1965-10| pmid = 5838328}}</ref><ref>{{cite book | last = Ferri | first = Fred | title = Ferri's Clinical Advisor 2016 5 Books in 1 | publisher = Elsevier Science Health Science | location = City | year = 2015 | isbn = 978-0323280471 }}</ref><ref name="pmid14217136">{{cite journal| author=KLIPSTEIN FA| title=ANTIBIOTIC THERAPY IN TROPICAL SPRUE: THE ROLE OF DIETARY FOLIC ACID IN THE HEMATOLOGIC REMISSION ASSOCIATED WITH ORAL ANTIBIOTIC THERAPY. | journal=Ann Intern Med | year= 1964 | volume= 61 | issue= | pages= 721-8 | pmid=14217136 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14217136 }} </ref><ref name="pmid13911562">{{cite journal| author=SHEEHY TW, RUBINI ME, PEREZ-SANTIAGO E, SANTINI R, HADDOCK J| title=The effect of "minute" and "titrated" amounts of folic acid on the megaloblastic anemia of tropical sprue. | journal=Blood | year= 1961 | volume= 18 | issue= | pages= 623-36 | pmid=13911562 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13911562 }} </ref> | |||
:* Preferred regimen (1): [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Tetracycline]] 250 mg PO qid for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease | :* Preferred regimen (1): [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Tetracycline]] 250 mg PO qid for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease | ||
:* Preferred regimen (2): [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Doxycycline]] 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease | :* Preferred regimen (2): [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Doxycycline]] 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease | ||
:* Alternative regimen: [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Ampicillin]] 500 mg bid for ≥ 4 weeks | :* Alternative regimen: [[Folic acid]] 5 mg PO bid for 2 weeks, followed by 1 mg PO tid {{and}} [[Ampicillin]] 500 mg bid for ≥ 4 weeks | ||
:: Note: Vitamin B12 deficiency may be corrected with [[Vitamin B12]] 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months. | :: Note: [[Vitamin B12 deficiency]] may be corrected with [[Vitamin B12]] 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months. | ||
* Patients with [[anemia]] can be supplemented with iron, folic acid and vitamin B12. | |||
=== | ===Duration of Therapy=== | ||
[[Tropical sprue]] should be treated by a course of the antibiotic [[tetracycline]] and [[vitamin B12]] and [[Folic Acid|folic acid]] for at least 6 months. | |||
* In chronic [[diarrhea]] and malabsorption, the antioxidant defence system in the gut is impaired. [[Tetracycline]] acts as an anti-inflammatory agent to restore function of the [[enterocyte]] in combination with the [[Mucous membrane|mucosal]] repair agent, [[Folic Acid|folic acid]]. | |||
* [[Folic Acid|Folic acid]] is both depleted by damage to the host epithelium in [[malabsorption]] in infection and is also ultilized and taken up by [[bacteria]] for essential biosynthesis of cellular components. In bacterial overgrowth, further depleting the [[folate]] pool. So, [[Folic Acid|folic acid]] supplements are necessary in effective therapy for [[tropical sprue]].<ref name="Walker2003">{{cite journal|last1=Walker|first1=Marjorie M|title=What is tropical sprue?|journal=Journal of Gastroenterology and Hepatology|volume=18|issue=8|year=2003|pages=887–890|issn=0815-9319|doi=10.1046/j.1440-1746.2003.03127.x}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WS}} | |||
{{WH}} | |||
[[Category:Gastroenterology]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 00:30, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Folic acid and antimicrobial therapy are the mainstay of treatment for tropical sprue. Supportive therapy includes adequate hydration and replacement of nutrients such as iron and vitamin B12. Oral Tetracycline is contraindicated among pregnant and lactating women and among children < 8 years of age. The main aims of treatment include: control of diarrhea, correction of existing vitamin deficiencies and cure of the disease.
Medical Therapy
Medical therapy for tropical sprue includes antibiotics and folate supplementation.[1][2][3][4]
- Preferred regimen (1): Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Tetracycline 250 mg PO qid for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease
- Preferred regimen (2): Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Doxycycline 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease
- Alternative regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Ampicillin 500 mg bid for ≥ 4 weeks
- Note: Vitamin B12 deficiency may be corrected with Vitamin B12 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months.
- Patients with anemia can be supplemented with iron, folic acid and vitamin B12.
Duration of Therapy
Tropical sprue should be treated by a course of the antibiotic tetracycline and vitamin B12 and folic acid for at least 6 months.
- In chronic diarrhea and malabsorption, the antioxidant defence system in the gut is impaired. Tetracycline acts as an anti-inflammatory agent to restore function of the enterocyte in combination with the mucosal repair agent, folic acid.
- Folic acid is both depleted by damage to the host epithelium in malabsorption in infection and is also ultilized and taken up by bacteria for essential biosynthesis of cellular components. In bacterial overgrowth, further depleting the folate pool. So, folic acid supplements are necessary in effective therapy for tropical sprue.[5]
References
- ↑ Guerra, R.; Wheby, M. S.; Bayless, T. M. (1965-10). "Long-term antibiotic therapy in tropical sprue". Annals of Internal Medicine. 63 (4): 619–634. ISSN 0003-4819. PMID 5838328. Check date values in:
|date=(help) - ↑ Ferri, Fred (2015). Ferri's Clinical Advisor 2016 5 Books in 1. City: Elsevier Science Health Science. ISBN 978-0323280471.
- ↑ KLIPSTEIN FA (1964). "ANTIBIOTIC THERAPY IN TROPICAL SPRUE: THE ROLE OF DIETARY FOLIC ACID IN THE HEMATOLOGIC REMISSION ASSOCIATED WITH ORAL ANTIBIOTIC THERAPY". Ann Intern Med. 61: 721–8. PMID 14217136.
- ↑ SHEEHY TW, RUBINI ME, PEREZ-SANTIAGO E, SANTINI R, HADDOCK J (1961). "The effect of "minute" and "titrated" amounts of folic acid on the megaloblastic anemia of tropical sprue". Blood. 18: 623–36. PMID 13911562.
- ↑ Walker, Marjorie M (2003). "What is tropical sprue?". Journal of Gastroenterology and Hepatology. 18 (8): 887–890. doi:10.1046/j.1440-1746.2003.03127.x. ISSN 0815-9319.