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.

Keywords:

• Ceftriaxone
• doxycycline
• trimethoprim–sulfamethoxazole; Tropheryma whipplei
• Whipple’s disease

Acknowledgements

We are grateful to Susan West for reading and correcting the manuscript.

The corresponding author confirms that he listed everyone who contributed significantly to the work. All authors approved the final version of the manuscript.

This work received no funding.

Disclosure statement

The authors have no conflict of interest.