How do you treat osteoarticular TB?
Current guidelines from Centers for Disease Control and Prevention, American Thoracic Society, and Infectious Disease Society of America recommend 6–9 months of therapy. Standard treatment includes four drugs initially: isoniazid (5 mg/kg, up to 300 mg daily), rifampin (10 mg/kg, up to 600 mg daily), ethambutol (15 mg/kg daily, up to 1600 mg daily), and pyrazinamide (15–30 mg/kg, up to 2 g daily). Once the MTB is confirmed sensitive to isoniazid, ethambutol can be discontinued. Pyrazinamide is administered only in the intensive phase (first 2 months). Patients with drug-susceptible TB are treated with isoniazid and rifampin daily in the continuation phase of therapy. Patients with multidrug-resistant TB (1% of all US cases) should be treated with other drug regimens prescribed by an expert in TB therapy for 18 to 24 months or longer.
For those with arthritis or minimal osteomyelitis, antituberculous therapy is often the only therapy needed. However, if bone involvement is extensive, spinal kyphosis is greater than 40 degrees, multidrug-resistant TB is present, or there is neurologic compromise, surgery is often necessary to debride the abscess and hasten recovery.
