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Efficacy of ceftriaxone or meropenem as initial therapies in Whipple's disease
Gerhard E Feurle1, Natascha S Junga, Thomas Marth
1DRK Krankenhaus, Neuwied, Germany. g.e.feurle@t-online.de
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 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.
Insights
This randomized controlled trial found that ceftriaxone or meropenem followed by trimethoprim-sulfamethoxazole effectively treats Whipple's disease, achieving long-term remission in most patients. One patient with cerebrospinal fluid infection required additional therapy.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Trials
Background:
- Whipple's disease is a chronic infection caused by Tropheryma whipplei.
- Effective antimicrobial therapy is crucial for managing this rare condition.
- Identifying treatments that cross the blood-brain barrier is important for comprehensive care.
Purpose of the Study:
- To evaluate the efficacy of ceftriaxone and meropenem in treating Whipple's disease.
- To compare the long-term remission rates of two distinct antimicrobial regimens.
- To assess the safety and effectiveness of antimicrobials crossing the blood-brain barrier.
Main Methods:
- A randomized controlled trial involving 40 treatment-naive patients from Central Europe.
- Two groups received 14-day infusions of either ceftriaxone (2g daily) or meropenem (3g daily).
- All patients subsequently received 12 months of oral trimethoprim-sulfamethoxazole, with a 3-year follow-up for remission.
Main Results:
- All 40 patients achieved clinical and laboratory remission.
- Remission was sustained throughout the follow-up period for all patients, barring two unrelated deaths.
- One patient with asymptomatic cerebrospinal fluid infection, resistant to initial treatments, responded to chloroquine and minocycline.
Conclusions:
- Ceftriaxone or meropenem, followed by trimethoprim-sulfamethoxazole, provides a curative treatment for Whipple's disease.
- The study demonstrates high efficacy and sustained remission rates.
- Additional targeted therapy may be necessary for specific cases, such as asymptomatic cerebrospinal fluid infections.
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