Pott's disease medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Pott's disease can be treated with antituberculous drugs and should be closely monitored to assess the response to therapy and compliance with medication. To effectively treat Pott's disease, it is crucial that patients take their medications exactly as prescribed.
Medical Therapy
Treatment must be initiated in all patients as early as possible and waiting for the culture results should not delay the treatment. Empiric therapy must be initiated in all patients. Treatment options and duration of therapy is controversial.
Duration of Therapy
WHO Recommendations
- WHO recommends a 9 month duration of therapy with a initial 2-month intensive course combination of four first line drugs: isoniazid, rifampicin, streptomycin, and pyrazinamide; followed by a continuation therapy.
American Thoracic Society Recommendations
- The American Thoracic Society recommends 6 months of therapy in adults and 12 months in children.
British Thoracic Society Recommendations
- The British Thoracic Society recommends 6 months therapy; four drug regimen in the first 2 months with rifampicin, isoniazid, pyrazinamide and with ethambutol or Streptomycin, followed by 4 months daily administration of rifampin and isoniazid.
- Corticosteriods can be used only in cases with spinal arachnoiditis or nonosseous spinal tuberculosis.
Treatment Regimen
- Intensive phase
- Preferred regimen: Isoniazid 300 mg PO (5 mg/kg/day) qd for 8 weeks AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 8 weeks AND Pyrazinamide 2 g PO (25 mg/kg/day) qd for 8 weeks AND Ethambutol 1.6 g PO (15 mg/kg/day) qd for 8 weeks
- Continuation phase
- Preferred regimen (1): Isoniazid 300 mg PO (5 mg/kg/day) qd AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 18 weeks
- Preferred regimen (2): Isoniazid 300 mg PO twice weekly (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
Response to Treatment
Clinically, reduction in pain, improvement of neurological deficit and correction of spine deformity indicate response to treatment.