Tropical sprue medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Control of diarrhea=== | ===Control of diarrhea=== | ||
Necessary to prevent concurrent fluid and electrolyte losses. | Necessary to prevent concurrent fluid and electrolyte losses.<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> | ||
:* 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. | ||
===Correction of Anemia=== | |||
* Patients with hematocrit < 10% are treated best with partial exchange transfusion, to prevent circulatory overload. | |||
* Patients with mild anemia can be treated by administration of Iron, Folic acid, Vitamin B12. | |||
===Chronic Pharmacotherapies=== | ===Chronic Pharmacotherapies=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 B. 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
Control of diarrhea
Necessary to prevent concurrent fluid and electrolyte losses.[1][2]
- 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.
Correction of Anemia
- Patients with hematocrit < 10% are treated best with partial exchange transfusion, to prevent circulatory overload.
- Patients with mild anemia can be treated by administration of Iron, Folic acid, Vitamin B12.
Chronic Pharmacotherapies
Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline and vitamins B12 and folic acid for at least 6 months.
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.