title: What is the best therapy for Whipple's disease? Our point of view.
abstract: Although Whipple's disease (WD) has been treated with antibiotics since the early 50s, the best antibiotics and the duration of the therapy have not yet been established. We consider here the pro and cons of the two most commonly used therapies, ceftriaxone followed by trimethoprim-sulfamethoxazole (TMP-SMZ) and hydroxychloroquine in combination with doxycycline. The therapy based on ceftriaxone and TMP-SMZ is efficient in the vast majority of patients for the first few years. However, since reinfections or reactivations can occur, a life-long prophylaxis is necessary and doxycycline is nowadays the best option. We thus propose a therapy based on merging these to therapies together, ceftriaxone, and TMP-SMZ for the first year(s) and then life-long prophylaxis with doxycycline.
authors.affiliation: a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Biagi
authors.affiliation: b Department of Pharmacology , University of Bologna , Bologna , Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Biagi
authors.affiliation: a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy.
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005243:Feces / Q000382:microbiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D054851:Tropheryma / Q000187:drug effects; D008061:Whipple Disease / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline
keywords: Ceftriaxone; Whipple’s disease; doxycycline; trimethoprim–sulfamethoxazole; Tropheryma whipplei