What is the role of pharmacologic therapy in the treatment of Pott disease (tuberculous [TB] spondylitis)?

Updated: Aug 08, 2019
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Practice guidelines issued in 2016 by the US Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America, and the American Thoracic Society continue to recommend a 4-drug regimen for empirical treatment of Pott disease. [48] Identifying the susceptibility pattern of the particular strain, if possible, is important in order to adjust the treatment regimen and duration accordingly.

Isoniazid and rifampin should be administered during the whole course of therapy. Additional drugs are administered during the first 2 months of therapy. These are generally chosen from among the first-line drugs, which include pyrazinamide, ethambutol, and streptomycin. The use of second-line drugs is indicated in cases of drug resistance. [49]

Treatment duration

Studies performed by the British Medical Research Council indicate that tuberculous spondylitis of the thoracolumbar spine should be treated with combination chemotherapy for 6-9 months. [50]

However, the research council’s studies did not include patients with multiple vertebral involvement, cervical lesions, or major neurologic involvement. Because of these limitations, many experts still recommend chemotherapy for 9-12 months. [48]

For selected cases with surgical indication that allows complete debridement of the lesion, a combination of surgery and ultra-shortened course of therapy (4.5 mo), appears to show comparable outcomes of a combination of surgery and 9 months of drug therapy. [51]


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