title: Intravenous ceftriaxone, followed by 12 or three months of oral treatment with trimethoprim-sulfamethoxazole in Whipple's disease.
abstract: BACKGROUND
  There is no agreement on how and for how long Whipple's disease should be treated. In a randomized trial it was shown that patients can be cured with ceftriaxone or meropenem followed by trimethoprim-sulfamethoxazole for 12 months. The present study tested whether trimethoprim-sulfamethoxazole for three months is sufficient.
  
  
  METHODS
  In the time from July 2004 to July 2008, 40 untreated patients from central Europe were sequentially admitted to an open-label, non-randomized extension of the previous trial with essentially an identical protocol. The modified treatment consisted of 2 g ceftriaxone intravenously once daily for 14 days followed by oral trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 months. Primary endpoint was treatment efficacy compared with the previous study.
  
  
  RESULTS
  Twelve months of treatment with trimethoprim-sulfamethoxazole was not more effective than 3 months as indicated by clinical findings, laboratory (p = 0.405, p = 0.631, resp.), and histological data (p = 0.456). 36 of 37 surviving patients including 14 with cerebrospinal infection were in remission without evidence of recurrence after a median follow-up time of 80 months. In one patient, Tropheryma whipplei arthritis recurred 63 months after initial therapy. Secondary endpoints indicate that histology of intestinal biopsies was a more useful indicator to determine eradication of T. whipplei than PCR. In submucosal and extra-intestinal tissue, the diagnostic value of the PCR was superior. Prospective data disclosed a heterogeneous spectrum of clinical presentation and course of Whipple's disease.
  
  
  CONCLUSIONS
  This study indicates that ceftriaxone followed by three months of trimethoprim-sulfamethoxazole is highly efficacious in the treatment of Whipple's disease.
authors.affiliation: DRK Krankenhaus Neuwied, Innere Medizin I, Marktstr. 104, 56564 Neuwied, Germany. g.e.feurle@t-online.de
authors.forename: Gerhard E
authors.initials: GE
authors.lastname: Feurle
authors.forename: Verena
authors.initials: V
authors.lastname: Moos
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bläker
authors.forename: Christoph
authors.initials: C
authors.lastname: Loddenkemper
authors.forename: Annette
authors.initials: A
authors.lastname: Moter
authors.forename: Andrea
authors.initials: A
authors.lastname: Stroux
authors.forename: Thomas
authors.initials: T
authors.lastname: Marth
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004724:Endoscopy; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D054851:Tropheryma / Q000187:drug effects*; D008061:Whipple Disease / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination