American Journal of Clinical Nutrition, Vol 24, 1327-1336, Copyright © 1971 by The American Society for Clinical Nutrition, Inc.

Response of tropical sprue to poorly absorbed sulfonamides and oxytetracycline

¹ From the Hematology Section, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico

Eight patients with tropical sprue, treated with sulfasuxidine or sulfaguanidine for 6 months, were compared with six others who received oxytetracycline. A clinical, gastroenterologic, and hematologic remission was obtained in all patients. The xylose absorption became normal in 12 of the 14 patients and steatorrhea was not encountered after therapy in 11 of the subjects tested. The jejunal lesion was significantly improved in all cases, but normal specimens were not obtained in any patient. The hemoglobin after therapy was over 12.5 g/100 ml in all cases and normoblastic erythropoiesis was present in 11 subjects. The hematologic response occurred during the 3rd to the 10th week in the patients treated with sulfasuxidine and sulfaguanidine, whereas those who received oxytetracycline responded in less than 8 weeks. During the hematologic response serum vitamin B₁₂ levels increased in all patients, although serum folate levels remained unchanged or low. After therapy, normal serum vitamin B₁₂ levels were found in 9 of 14 patients and serum folate levels were normal in 6 of the 14 patients. One patient, treated initially with sulfaguanidine, developed an exacerbation of the disease after receiving no therapy for 26 months, yet he had an adequate response to sulfasuxidine. Poorly absorbed sulfonamides, as well as oxytetracycline, are effective in the treatment of tropical sprue. Increased intestinal absorption of vitamin B₁₂ is a main factor involved in the hematologic response observed in those patients so treated. One patient, who was taking folic acid for 4 years, had an exacerbation of the disease and responded well to oxytetracycline. Antibacterial agents in tropical sprue seem to ameliorate the inflammatory reaction that may be produced by microorganisms or to change an abnormal intestinal flora to a normal one. This, in turn, allows the intestinal mucosa to regain its normal function.