Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis

Abstract

Background:Most important cause of treatment failure and emergence of drug resistance in the treatment of tuberculosis is noncompliance. Compliance can be improved by direct observation of drug intake, intermittent therapy, and short-course treatment. The efficacy of Directly Observed Treatment Short Course (DOTS) strategy advocated by World Health Organization (WHO) in spinal tuberculosis is not yet proven. We conducted a prospective clinical study on a consecutive series of patients with spinal tuberculosis treated by Category I Revised National Tuberculosis Control Programme (RNTCP) regimen based on DOTS strategy of WHO from 2004 to 2007 to evaluate the efficacy.Materials and Methods:Forty-nine consecutive patients of spinal tuberculosis were treated with short-course intermittent chemotherapy under Category I RNTCP/DOTS strategy. Patients were followed up for a minimum period of 2 years. Surgery was done if the patient presented with significant neurologic deficit or when the drug treatment failed. Outcome was assessed by clinical, radiologic, and laboratory criteria, and graded into excellent, good, fair, and poor based on various parameters.Results:63.4% (n=26) of the patients had excellent results. 14.6% (n=6) of the patients had good and fair results. Three patients (7.3%) had poor results 48.7% (n=20) of the patients had but only one of them was severe enough to warrant change of drug.Conclusions:Efficacy of DOTS was comparable with other standard regimens. There was a significant reduction in adverse side effects when compared with daily regimens. Study showed that the outcome was better in those treated early.

Results of management of spinal tuberculosis according to middle path regime and short course chemotheraphy

“…Intermittent therapy is as effective as daily therapy. 3 In our study one patient had drugs associated rashes but it subsided on topical steroids.…”

“…Isoniazid (H) (600 mg), Rifampicin (R) (450 mg), Pyrazinamide (P) (1500 mg), Ethambutol (E) (1200 mg), Streptomycin (S) (750 mg). 3 Patients who weighed 60 kg or more receive additional 150mg of Rifampicin. Patients who were more than 50 years old received only 500 mg of Streptomycin.…”

Atypical Presentations of Tuberculosis

“…[7]  Evidences of associated extraskeletal tuberculosis like cough, expectoration, lymphadenopathy, diarrhoea and abdominal distension may be seen. [8] DISCUSSION OF MANAGEMENT Case I The patient was initially thought to be having a subacute osteomyelitis or a benign tumour. It was proceeded with Open Biopsy.…”

Central Nervous System Tuberculosis

“…56 One of the complications of Pott disease that can be detected through imaging is the presence of syringomyelia. 45 Surgical intervention is indicated in patients with spinal instability due to vertebral body collapse and in those presenting with compression-related neurological symptoms. 64,65 The disease has a more favorable response to treatment the earlier it is diagnosed.…”

“…Multiple chemotherapy treatments are used to treat Pott disease, which include regimens that combine streptomycin, rifampicin, isoniazid, and ethambutol. 45,56 Imageguided interventional procedures are used in the diagnosis of the lesion and also in the drainage of the abscesses. 45 Surgical intervention is indicated in patients with spinal instability due to vertebral body collapse and in those presenting with compression-related neurological symptoms.…”