Is 6 Months of Antitubercular Chemotherapy as Effective as More Than 6 Months Regimen in Spinal Tuberculosis? A Systematic Review and Meta-analysis

Abstract

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92–1.04; <i>p</i> =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, <i>p</i> =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.

Tuberculous Flexor Tenosynovitis with Median Nerve Compression

“…Earlier recommendations for duration of antitubercular chemotherapy for extrapulmonary tuberculosis was for at least 12 months. Recent studies suggest duration of 6 months might also suffice 14 , but this has not yet been conclusively proven, and hence, we still recommend chemotherapy for at least 12 months. Recurrence is not uncommon, especially with noncompliance to chemotherapy 15 .…”

Brucellar Knee Arthritis with Knee Joint Tuberculosis: A Case Report and Review of the Literature

“…However, most centers continue to use long-term chemotherapy regimens. 28 , 29 Aryal et al 29 compared the efficacy of short-term treatment and long-term treatment in patients with spinal tuberculosis; the results showed no significant difference in curative rates of relapse between the two regimens. In this article, the patient was treated with a 9-month chemotherapy regimen: 3-month intensive therapy (isoniazid, rifampicin, pyrazinamide, ethambutol) and 6-month consolidation therapy (isoniazid, rifampicin).…”

“…Brucellar knee arthritis and knee joint tuberculosis overlap in the use of rifampicin treatment, but the use of an anti-brucellar regime cannot achieve a cure for tuberculosis. 17 , 29 Delayed diagnosis and treatment will not arrest the progression of knee joint tuberculosis.…”

Musculoskeletal tuberculosis with multifocal muscle abscesses in a healthy young adult

“…Furthermore, for spinal tuberculosis with evidence of meningitis the suggestive duration of treatment is also 12 months, including consideration of adjunctive corticosteroids [5]. However, the optimal length of anti-tuberculous treatment for bone, joint, and spinal tuberculosis is open for debate since various published cases demonstrate successful short-course (6 months) treatment that leads to better patient compliance, decreased cost, and fewer side effects of the medications [6].…”