Tropical Sprue Treatment & Management

Updated: Dec 24, 2020
  • Author: Rohan C Clarke, MD; Chief Editor: Burt Cagir, MD, FACS  more...
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Treatment

Approach Considerations

Patients with tropical sprue are not usually admitted as inpatients unless they present with a diagnosis of chronic diarrhea or malabsorption with dehydration and weight loss (see Medical Care).

Patients admitted with suspected tropical sprue should undergo workup and evaluation as previously described (see Workup).

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Medical Care

Patients with tropical sprue rarely present to the emergency department (ED) with the following symptoms. Unless folate or vitamin B-12 deficiencies are noted, the diagnosis will probably be made later. The symptoms require urgent evaluation and initiation replacement of deficient nutrients, fluid, and electrolytes. Hospital admission is indicated in complicated cases. Symptoms include the following:

  • Acute diarrhea

  • Volume depletion

  • Electrolyte imbalance

  • Symptomatic anemia

  • Leg swelling

Without treatment, tropical sprue runs a relapsing course and can result in severe malnutrition.

Useful therapeutic interventions involve antibiotics and replacement of nutrients (eg, folic acid, vitamin B-12, iron), deficient fluid, and sometimes blood. However, despite success reported in other regions, antibiotic therapy for tropical sprue is not useful in patient populations of southern India.

Generally, administer a combination of antibiotics and folic acid to patients for 3-6 months. Patients with symptoms persisting longer than 6 months may be administered the combination for as long as a year.

Tetracycline 250 mg po QID for up to 4 months.

Folic acid 5 mg po daily for up to four months

Assess patients' responses by improvement of symptoms, weight gain, and correction of the macrocytic anemia. The duration of treatment depends on the duration of symptoms. This is notable with regards to Vitamin B 12 1000 mcg IM injections weekly.

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Long-Term Monitoring

Observe patients regularly to ensure that they respond to treatment and that the correct diagnosis is made. The patient should be observed at least once a month with careful monitoring of lab studies to make sure that any signs or symptoms of malabsorption have been corrected.

Monitor weight gain.

Monitor the patient's complete blood cell (CBC) count and electrolytes at least monthly.

Correct folate, vitamin B-12, and any other deficiencies.

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