Pott's disease medical therapy

Pott’s disease is treated with antituberculous drugs, for a duration of 6 months to 9 months. Patients must be closely monitored to assess the response to therapy and compliance with medication.

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.^[1]

• 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 7 month continuation therapy.^[2]

• The American Thoracic Society recommends 6 months of therapy in adults and 12 months in children.^[3]

• 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.^[4]
• Corticosteriods should be used only in cases with spinal arachnoiditis or nonosseous spinal tuberculosis.^[5]

• 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

Clinically, reduction in pain, improvement of neurological deficit and correction of spine deformity indicate response to treatment.^[6]

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