Treatments and drugs
Treatment of Whipple 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 destroy the bacteria. But relief from symptoms typically comes much quicker, often within the first week or two. 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. If you relapse during treatment, your doctor may change your antibiotics.
Treatment for standard cases
In most cases, Whipple disease therapy begins with two to four weeks of intravenous (IV) ceftriaxone (Rocephin) or penicillin. Following that initial therapy, you'll likely take an oral course of sulfamethoxazole-trimethoprim, or SMX-TMP (Bactrim, Septra), for one to two years. A shorter duration of antibiotic treatment may lead to a relapse.
Possible side effects of ceftriaxone and SMX-TMP include mild diarrhea, nausea and vomiting.
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 SMX-TMP.
Possible side effects of doxycycline include loss of appetite, nausea, vomiting and sensitivity to sunlight. Hydroxychloroquine may cause loss of appetite, diarrhea, headache, stomach cramps and dizziness.
Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month.
But even though symptoms improve quickly, further laboratory tests may reveal the 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.
Even after successful treatment, Whipple disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.
Because of the nutrient-absorption difficulties associated with Whipple 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.