Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple’s Disease.

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Efficacy of Ceftriaxone or Meropenem as Initial Therapies in Whipple's Disease.

Gastroenterology. 2009 Oct 28;

Authors: Feurle GE, Junga NS, Marth T

BACKGROUND&AIMS:: 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 randomly assigned 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 months, range 71-128 months), 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 endpoint (remission for at least 3 years) was 0.95 (95 % confidence interval 0.05-16.29, P=1.0). CONCLUSION:: This is the first 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.

PMID: 19879276 [PubMed - as supplied by publisher]

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