Long-term Antibiotic Therapy in Tropical Sprue

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Abstract
Seventeen patients with tropical sprue were studied before and after a 6 month course of therapy with tetracycline or oxytetracycline. Nine patients had had persistent symptoms and malabsorption despite prolonged treatment with folic acid and Vitamin B12 (Group I). Eight patients were previously untreated (Group II). Clinical and laboratory improvement was seen in all 17 patients. Group I showed: an average weight gain of 16 lbs.; return of serum carotene to normal in all; return of xylose test to normal in 8 of the 9 patients; decrease in fecal fat excretion, from an average of 25 gm/day per patient to 5.8 gm, becoming normal in 5 of the 9 patients. The patients of Group II showed: an average weight gain of 21 lbs.; return of the xylose test and serum carotene to normal in all 8; decrease in fecal fat excretion from an average of 19 gm/day per patient to 5.3 gm, becoming normal in 6 patients; hematological improvement in every patient. Biopsies of jejunal mucosa showed improvement in both groups but was more striking in Group II. Heal mucosal improvement paralleled jejunal improvement. Vitamin B12 absorption improved in all patients tested; normal values were found in 13 of 14 patients tested at the end of therapy. The use of long term antibiotic therapy in tropical sprue has thus been shown to be highly effective and to improve the prognosis of this disease. The precise mechanism of action is uncertain but the evidence favors an antimicrobial effect.

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