More than 100 years after its first description, the diagnosis and treatment of Whipple's disease is still a subject of controversy (Schneider, T. et al. : Whipple's disease: new aspects of pathogenesis and treatment. Lancet Infect, Dis. 8 (2008) 179 - 190. In my opinion an antibiotic treatment for one year is not enough.
2 g ceftriaxone iv daily for 14 days, followed by oral cotrimoxazole 160/800 for 3 months
Thank you very much, but let me know, whether there is - in severe cases with neurological deficits - a long term ceftriaxone therapy necessary?
This publication of 2008 is outdated. See instead: Feurle GE et al. Gastroenterology 2010;138:478-486 and Feurle GE et al. Journal of Infection 2013;66:263-270
Both prospective studies, the first randomised
See the publications quoted: 2 weeks ceftriaxone
There is no evidence that longer Treatment is more effective
Long term follow-up advisable in all patients.
Es gibt eine aktuelle deutsche Arbeit im Schattauer Verlag: Feurle GE Diagnose und Therapie bei Morbus Whipple. arthritis + rheuma 4/2013 p: 229-233
Beware of IRIS!
Feurle GE Annals of Internal Medicine 2010;153:710-717
In "severe cases of neurolological deficits" you will have to find out whether you are dealing with an continous cerbral infection or an postinfectious defect. (Defect healing). The latter of course is not reversed by the use of antibiotics. In the case of a resistent cerebral infection with T. whipplei, the combination of chloroquine and minocycline (Feurle et al: J Antimicrob Chemother 2012; 67:1295-1296) has been effective in one patient. I do not recommend longterm ceftriaxone.
Gerhard E. Feurle
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