Whipple's disease medical therapy

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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

The mainstay of treatment for Whipple's disease is systemic long-term antibiotic therapy.

Medical Therapy

• Pharmacologic medical therapy for Whipple's disease includes long-term antibiotics. Preferred regimens for initial therapy include Ceftriaxone or Penicillin G or Meropenem if allergic. One year of Trimethoprim-sulfamethoxazole is used for maintenance therapy. In case of sulfa allergy, the combination of Doxycycline and Hydroxychloroquine is used.

Classic Whipple's disease

• Initial therapy
  • Preferred regimen (1): Ceftriaxone 2 g IV qd for 14 days
  • Preferred regimen (2): Penicillin G 2 million units IV q4h for 14 days
  • Alternative regimen (1): Meropenem 1 g IV q8h for 14 days
• Maintenance therapy
  • Preferred regimen (1): Trimethoprim-sulfamethoxazole one DS tablet PO q12h for 1 year
  • Alternative regimen (1): Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year

CNS infection

• Initial therapy
  • Preferred regimen (1): Ceftriaxone 2 g IV qd for 14-28 days
  • Preferred regimen (2): Penicillin G 4 million units IV q4h for 14-28 days
  • Alternative regimen (1): Meropenem 1 g IV q8h for 14-28 days
• Maintenance therapy
  • Preferred regimen (1): Trimethoprim-sulfamethoxazole one DS tablet PO q12h for 1 year
  • Alternative regimen (1): Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year

Endocarditis

• Initial therapy
  • Preferred regimen (1): Penicillin G 2 million units IV q4h for 28 days
  • Preferred regimen (2): Ceftriaxone 2 g IV qd for 28 days
  • Alternative regimen (1): Meropenem 1 g IV q8h for 28 days
• Maintenance therapy
  • Preferred regimen (1): Trimethoprim-sulfamethoxazole one DS tablet PO q12h for 1 year
  • Alternative regimen (1): Doxycycline 100 mg PO q12h AND Hydroxychloroquine 200 mg PO q8h for 1 year

Relapse

• Initial therapy
  • Preferred regimen (1): Penicillin G 4 million units IV q4h for 28 days
  • Preferred regimen (2): Ceftriaxone 2 g IV qd for 28 days
• Maintenance therapy
  • Preferred regimen (1): Doxycycline 100 mg PO q12h AND hydroxychloroquine 200 mg PO q8h for 1 year
  • Alternative regimen (1): Trimethoprim-sulfamethoxazole one DS tablet PO q12h for 1 year

References

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