Antibiotic Therapy in Tropical Sprue

Abstract

A Puerto Rican patient with tropical sprue and a megaloblastic anemia secondary to combined folic acid and vitamin B12 deficiency has been treated with oral antibiotics while maintained on a diet containing initially less than 10 [mu]g and subsequently 150 [mu]g of total folic acid activity. No hematologic response was observed until the diet containing the larger quantity of folic add was administered; this response was accompanied by a rise in serum folate level and 24-hour urinary folic acid excretion values towards normal, but no change in the serum vitamin B12 concentration. Jejunal absorption was shown to be improved at this time. Subsequent therapy with 25 ug of free folic acid was required to produce a complete hematologic response; even this additional therapy did not result in complete replenishment of folate stores. This study indicates that an adequate dietary supply of folic add is a prerequisite for oral antibiotic therapy to produce a hematologic remission of the megaloblastic anemia associated with tropical sprue. It further suggests that the mechanism whereby oral antibiotic therapy achieves this remission is by improving jejunal absorptive capacity such that sufficient quantities of dietary folic acid are absorbed.