Tropical sprue medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Folic acid and antimicrobial therapy are the mainstay of treatment for tropical sprue. Supportive therapy includes adequate hydration and replacement of nutrients such as iron and vitamin B. Oral [[Tetracycline]] is contraindicated among pregnant and lactating women and among children < 8 years of age. The main aims of treatment include: control of diarrhea, correction of existing vitamin deficiencies and cure of the disease. | Folic acid and antimicrobial therapy are the mainstay of treatment for tropical sprue. Supportive therapy includes adequate hydration and replacement of nutrients such as iron and vitamin B. Oral [[Tetracycline]] is contraindicated among pregnant and lactating women and among children < 8 years of age. The main aims of treatment include: control of diarrhea, correction of existing vitamin deficiencies and cure of the disease. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Control of diarrhea=== | ===Control of diarrhea=== | ||
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* Patients with hematocrit < 10% are treated best with partial exchange transfusion, to prevent circulatory overload. | * Patients with hematocrit < 10% are treated best with partial exchange transfusion, to prevent circulatory overload. | ||
* Patients with mild anemia can be treated by administration of Iron, Folic acid, Vitamin B12. | * Patients with mild anemia can be treated by administration of Iron, Folic acid, Vitamin B12. | ||
===Chronic Pharmacotherapies=== | ===Chronic Pharmacotherapies=== | ||
Once diagnosed, tropical sprue can be treated by a course of the antibiotic [[tetracycline]] and vitamins B12 and folic acid for at least 6 months. | Once diagnosed, tropical sprue can be treated by a course of the antibiotic [[tetracycline]] and vitamins B12 and folic acid for at least 6 months. | ||
* In chronic diarrhea and malabsorption, the antioxidant defence system in the gut is impaired. Tetracycline might act as an anti-inflammatory agent to restore function of the enterocyte in combination with the mucosal repair agent, folic acid. Tetracycline is therefore, anti-inflammatory as well as bacteriostatic in TS. | |||
* Folic acid is both depleted by damage to the host epithelium in malabsorption in infection and is also ultilized and taken up by bacteria for essential biosynthesis of cellular components, thus, in bacterial overgrowth, further depleting the available folate pool. So, folic acid supplements are necessary in effective therapy for TS.<ref name="Walker2003">{{cite journal|last1=Walker|first1=Marjorie M|title=What is tropical sprue?|journal=Journal of Gastroenterology and Hepatology|volume=18|issue=8|year=2003|pages=887–890|issn=0815-9319|doi=10.1046/j.1440-1746.2003.03127.x}}</ref> | |||
==References== | ==References== | ||
Revision as of 19:46, 22 February 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Folic acid and antimicrobial therapy are the mainstay of treatment for tropical sprue. Supportive therapy includes adequate hydration and replacement of nutrients such as iron and vitamin B. Oral Tetracycline is contraindicated among pregnant and lactating women and among children < 8 years of age. The main aims of treatment include: control of diarrhea, correction of existing vitamin deficiencies and cure of the disease.
Medical Therapy
Control of diarrhea
Necessary to prevent concurrent fluid and electrolyte losses.[1][2]
- Preferred regimen (1): Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Tetracycline 250 mg PO qid for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease
- Preferred regimen (2): Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Doxycycline 100 mg PO qd for 4–6 weeks, up to 6 months in residents of the tropics who have had long-term disease
- Alternative regimen: Folic acid 5 mg PO bid for 2 weeks, followed by 1 mg PO tid AND Ampicillin 500 mg bid for ≥ 4 weeks
- Note: Vitamin B12 deficiency may be corrected with Vitamin B12 1000 mcg IM weekly for 4 weeks, followed by monthly for 3 to 6 months.
Correction of Anemia
- Patients with hematocrit < 10% are treated best with partial exchange transfusion, to prevent circulatory overload.
- Patients with mild anemia can be treated by administration of Iron, Folic acid, Vitamin B12.
Chronic Pharmacotherapies
Once diagnosed, tropical sprue can be treated by a course of the antibiotic tetracycline and vitamins B12 and folic acid for at least 6 months.
- In chronic diarrhea and malabsorption, the antioxidant defence system in the gut is impaired. Tetracycline might act as an anti-inflammatory agent to restore function of the enterocyte in combination with the mucosal repair agent, folic acid. Tetracycline is therefore, anti-inflammatory as well as bacteriostatic in TS.
- Folic acid is both depleted by damage to the host epithelium in malabsorption in infection and is also ultilized and taken up by bacteria for essential biosynthesis of cellular components, thus, in bacterial overgrowth, further depleting the available folate pool. So, folic acid supplements are necessary in effective therapy for TS.[3]
References
- ↑ Guerra, R.; Wheby, M. S.; Bayless, T. M. (1965-10). "Long-term antibiotic therapy in tropical sprue". Annals of Internal Medicine. 63 (4): 619–634. ISSN 0003-4819. PMID 5838328. Check date values in:
|date=(help) - ↑ Ferri, Fred (2015). Ferri's Clinical Advisor 2016 5 Books in 1. City: Elsevier Science Health Science. ISBN 978-0323280471.
- ↑ Walker, Marjorie M (2003). "What is tropical sprue?". Journal of Gastroenterology and Hepatology. 18 (8): 887–890. doi:10.1046/j.1440-1746.2003.03127.x. ISSN 0815-9319.