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Treatments and drugs
By Mayo Clinic staffTreatment of Whipple's disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection.
Treatment is long term, generally lasting a year or two, in an effort to completely eradicate the bacteria. But relief from symptoms typically comes much quicker, often within the first week. Most people with no brain or nervous system complications recover completely after a full course of antibiotics.
When choosing antibiotics, doctors often select those that not only wipe out infections of the intestinal tract, but also cross the blood-brain barrier — a layer of tissue around your brain — in order to eliminate bacteria that may have entered your brain and central nervous system.
Because of the lengthy use of antibiotics, your doctor will need to monitor your condition for development of resistance to the drugs.
Treatment for standard cases
In most cases, Whipple's disease therapy begins with 14 days of intravenous (IV) ceftriaxone (Rocephin). Following that initial therapy, you'll likely take an oral course of trimethoprim-sulfamethoxazole, or TMP-SMX, (Bactrim, Septra), for one to two years. A shorter duration of antibiotic treatment may lead to a relapse.
Another common treatment begins with 14 days of IV infusions of streptomycin and penicillin G, followed by oral TMP-SMX for one to two years.
Treatment for severe cases
If you have neurologic symptoms, you may be started immediately on a 12- to 18-month course of oral doxycycline (Vibramycin) combined with the antimalarial drug hydroxychloroquine (Plaquenil). You'll also be given long-term antibiotics that can enter the cerebrospinal fluid and brain, such as TMP-SMX.
For the most serious cases, you may be hospitalized and treated with fluids and electrolyte replacement via IV drip.
Symptom relief
Your symptoms should improve within one to two weeks of starting proper antibiotic treatment, and go away entirely within about one month.
But even though symptoms improve quickly, further laboratory tests may reveal presence of the bacteria for two or more years after you begin taking antibiotics. Follow-up testing will help your doctor determine when you can stop taking antibiotics. Regular monitoring can also indicate development of resistance to a particular drug, often reflected in a lack of improvement of your symptoms.
To manage joint pain, your doctor may recommend a nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin, others), as well.
If you have severe neurological symptoms or a long-lasting high fever, your doctor may also prescribe corticosteroids, which may help ease symptoms and reduce inflammation.
Even after successful treatment, Whipple's disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.
Taking supplements
Because of the nutrient-absorption difficulties associated with Whipple's disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.
- Whipple's disease. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/whipple/. Accessed April 20, 2010.
- Schneider T, et al. Whipple's disease: New aspects of pathogenesis and treatment. The Lancet. 2008;8:179.
- Infectious enterocolitis. In: Kumar V, et al. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/198838576-5/991412257/2060/201.html#4-u1.0-B978-1-4377-0792-2..50022-5--cesec139_1852. Accessed April 20, 2010.
- Apstein M, et al. Whipple's disease. http://www.uptodate.com/home/index.html. Accessed April 20, 2010.
- Marth T, et al. Whipple's disease. In: Mandell GL, et al. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 76th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier: 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-443-06839-3..00101-6--s0025&uniq=198838576&isbn=978-0-443-06839-3&sid=991410994#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-443-06839-3..00101-6--s0030%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-0-443-06839-3. Accessed April 30, 2010.
- Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. April 30, 2010.
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