Efficacy of ceftriaxone or meropenem as initial therapies in Whipple's disease.
OBJECTIVE
Whipple's disease is a chronic infection caused by the actinomycete Tropheryma whipplei. We conducted a randomized controlled trial of the efficacy of antimicrobials that are able to cross the blood-brain barrier and to which T whipplei is susceptible.


METHODS
Patients from central Europe with previously untreated Whipple's disease (n = 40) were assigned randomly to groups given daily infusions of either ceftriaxone (1 x 2 g, 20 patients) or meropenem (3 x 1 g, 20 patients) for 14 days, followed by oral trimethoprim-sulfamethoxazole for 12 months. The primary outcome measured was maintenance of remission for 3 years, determined by a composite index of clinical and laboratory data as well as histology.


RESULTS
All patients were observed for the entire follow-up period (median, 89 mo; range, 71-128 mo); all achieved clinical and laboratory remission. Remission was maintained in all patients during the time of observation, except for 2 who died from unrelated causes. A single patient with asymptomatic cerebrospinal infection who was resistant to both treatments responded to chloroquine and minocycline. The odds ratio for the end point (remission for at least 3 years) was 0.95 (95% confidence interval, 0.05-16.29; P = 1.0).


CONCLUSIONS
This was a randomized controlled trial to show that treatment with ceftriaxone or meropenem, followed by trimethoprim-sulfamethoxazole, cures patients with Whipple's disease. One asymptomatic individual with infection of the cerebrospinal fluid required additional therapy.
Feurle
Gerhard E
GE
DRK Krankenhaus, Neuwied, Germany. g.e.feurle@t-online.de
Junga
Natascha S
NS
Marth
Thomas
T
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007413:Intestinal Mucosa / Q000382:microbiology / Q000473:pathology; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D012074:Remission Induction; D013845:Thienamycins / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D054851:Tropheryma; D008061:Whipple Disease / Q000188:drug therapy* / Q000473:pathology
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077731:Meropenem