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Pott Disease Medication

  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
 
Updated: Jun 03, 2016
 

Medication Summary

A 4-drug regimen should be used empirically to treat Pott disease. Treatment can be adjusted when susceptibility information becomes available.

Isoniazid and rifampin should be administered during the whole course of therapy. Additional drugs are administered during the first 2 months of therapy and are generally chosen from among the first-line drugs, such as pyrazinamide, ethambutol, and streptomycin. (A 3-drug regimen usually includes isoniazid, rifampin, and pyrazinamide.) In cases of drug resistance, the use of second-line medications is indicated.

The duration of treatment is somewhat controversial. Although some studies favor a 6- to 9-month course, traditional courses range from 9 months to longer than 1 year. The duration of therapy should be individualized and based on the resolution of active symptoms and the clinical stability of the patient.[53, 54]

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Antitubercular Agents

Class Summary

These agents inhibit the growth and proliferation of the causative organism.

Isoniazid

 

Isoniazid is highly active against Mycobacterium tuberculosis. It has good gastrointestinal (GI) absorption and penetrates well into all body fluids and cavities.

Rifampin (Rifadin)

 

Rifampin is for use in combination with at least 1 other antituberculous drug. It inhibits deoxyribonucleic acid (DNA) ̶ dependent bacterial (but not mammalian) ribonucleic acid (RNA) polymerase. Cross resistance may occur.

Pyrazinamide

 

Pyrazinamide is bactericidal against M tuberculosis in an acid environment (macrophages). It has good absorption from the GI tract and penetrates well into most tissues, including the cerebrospinal fluid (CSF).

Ethambutol (Myambutol)

 

Ethambutol has bacteriostatic activity against M tuberculosis. The drug has good GI absorption. CSF concentrations remain low, even in the presence of meningeal inflammation.

Streptomycin

 

Streptomycin is bactericidal in an alkaline environment. Because it is not absorbed from the GI tract, the drug must be administered parenterally. Streptomycin exerts action mainly on extracellular tubercle bacilli. Only about 10% of the drug penetrates cells that harbor organisms. Streptomycin enters the CSF only in the presence of meningeal inflammation. Excretion is almost entirely renal.

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Contributor Information and Disclosures
Author

Jose A Hidalgo, MD Assistant Professor, Universidad Nacional Mayor de San Marcos; Attending Physician, Department of Internal Medicine, Division of Infectious Diseases, Guillermo Almenara Hospital, Peru

Jose A Hidalgo, MD is a member of the following medical societies: HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

George Alangaden, MD Professor, Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University School of Medicine

George Alangaden, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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MRI of a 31-year-old man with tuberculosis of the spine. Images show the thoracic spine before and after an infusion of intravenous gadolinium contrast. The abscess and subsequent destruction of the T11-T12 disc interspace is marked with arrowheads. Vertebral body alignment is normal. Courtesy of Mark C. Diamond, MD, and J. Antonio Bouffard, MD, Detroit, Mich.
MRI of the T11 in a 31-year-old man with tuberculosis of the spine. Extensive bone destruction consistent with tuberculous osteomyelitis is evident. The spinal cord has normal caliber and signal. No evidence of spinal cord compression or significant spinal stenosis is distinguishable. Courtesy of Mark C. Diamond, MD, and J. Antonio Bouffard, MD, Detroit, Mich.
 
 
 
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