Pott's disease medical therapy: Difference between revisions

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{{CMG}}
{{CMG}}
==Overview==
==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]].
[[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.
 
==Medical Therapy==
==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.<ref name="pmid27559464">{{cite journal| author=Kandwal P, G V, Jayaswal A| title=Management of Tuberculous Infection of the Spine. | journal=Asian Spine J | year= 2016 | volume= 10 | issue= 4 | pages= 792-800 | pmid=27559464 | doi=10.4184/asj.2016.10.4.792 | pmc=4995267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27559464  }} </ref>
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.<ref name="pmid27559464">{{cite journal| author=Kandwal P, G V, Jayaswal A| title=Management of Tuberculous Infection of the Spine. | journal=Asian Spine J | year= 2016 | volume= 10 | issue= 4 | pages= 792-800 | pmid=27559464 | doi=10.4184/asj.2016.10.4.792 | pmc=4995267 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27559464  }} </ref>

Revision as of 17:05, 28 March 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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.

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.[1]

Duration of Therapy

WHO Recommendations

American Thoracic Society Recommendations

British Thoracic Society Recommendations

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.[6]

References

  1. Kandwal P, G V, Jayaswal A (2016). "Management of Tuberculous Infection of the Spine". Asian Spine J. 10 (4): 792–800. doi:10.4184/asj.2016.10.4.792. PMC 4995267. PMID 27559464.
  2. "Communicable Diseases Module: 14. Diagnosis and Treatment of Tuberculosis".
  3. "Treatment of Tuberculosis American Thoracic Society, CDC, and Infectious Diseases Society of America".
  4. "Tuberculosis | recommendations | Guidance and guidelines | NICE".
  5. Prasad K, Singh MB, Ryan H (2016). "Corticosteroids for managing tuberculous meningitis". Cochrane Database Syst Rev. 4: CD002244. doi:10.1002/14651858.CD002244.pub4. PMC 4916936. PMID 27121755.
  6. Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G (2017). "Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases". Spinal Cord. 55 (1): 59–63. doi:10.1038/sc.2016.85. PMID 27241442.

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