Antimicrobial therapy in Whipple's disease

Indication	Agent	Duration
Initial therapy
Initial phase*
General infection	Ceftriaxone 2 g IV once daily OR Penicillin G 2 million units IV every four hours	Two weeks
Endocarditis	Penicillin G 2 million units IV every four hours OR Ceftriaxone 2 g IV once daily	Four weeks
Central nervous system disease^¶	Ceftriaxone 2 g IV once daily OR Penicillin G 4 million units IV every four hours	Two to four weeks
If ceftriaxone and penicillin allergic	Meropenem 1 g IV every eight hours	Two to four weeks
Maintenance phase
All infections	Trimethoprim-sulfamethoxazole one DS tablet twice daily	One year
If sulfa allergic	Doxycycline 100 mg PO twice daily PLUS Hydroxychloroquine 200 mg PO thrice daily	One year
Therapy for relapse
Initial phase*	Penicillin G 4 million units IV every four hours OR Ceftriaxone 2 g IV twice daily	Four weeks
Maintenance phase	Doxycycline 100 mg PO twice daily PLUS hydroxychloroquine 200 mg PO thrice daily OR Trimethoprim-sulfamethoxazole one DS tablet twice daily for one year	One year

IV: intravenously; IM: intramuscularly; DS: double-strength (one double-strength tablet is equivalent to 160 mg trimethoprim and 800 mg sulfamethoxazole); PO: orally.
* The initial phase is followed by the maintenance phase.
¶ Central nervous system disease includes neurologically asymptomatic patients with a positive cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test for Tropheryma whipplei as well as patients with Whipple's disease and neurologic symptoms despite a negative CSF PCR test.

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Antimicrobial therapy in Whipple's disease