The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children

SummaryObjectiveTo review literature regarding osteo-articular tuberculosis (OATB) and make recommendations made for the chemotherapy of children.MethodsKey words bone tuberculosis, joint tuberculosis, tuberculosis of the spine, tuberculous osteomyelitis were used to search Pubmed and further references obtained by cross referencing and searching the indices of known papers. Results were tabulated regarding regimens, treatment duration, treatment failure, death and relapse.ResultsTwenty one papers described treatment of OATB with isoniazid (INH), streptomycin and para-aminosalicylic acid in 2466 patients; 2.1% failed treatment, 1.3% died due to tuberculosis (TB), 2.2% relapsed. Seventy seven papers provide details of 2950 patients receiving INH, rifampicin (RMP) and pyrazinamide (PZA) based regimens. Fifteen described six months treatment which failed in 2.5%, no patients died and 1.3% of patients followed up relapsed. Sixteen papers described 6–11 months treatment which failed in 4.3% of patients, 0.86% died due to TB and 0.86% relapsed. Forty six papers described treatment for ≥12 months; treatment failed in 0.74% of patients and death due to TB occurred in 0.84% and 0.51% relapsed.ConclusionsThe majority of OATB cases in children (and adults) can be satisfactorily treated for 6 months with RMP and PZA based regimens; in spinal TB well documented cases of relapse and persistent signs of acute inflammatory response in some patients argue for caution with 6 month regimens at present. Dosages of INH (5–15 mg/kg), RMP (10–20 mg/kg), PZA (30–40 mg/kg), EMB (15–25 mg/kg) and SM (12–18 mg/kg) are recommended for treatment of children. Daily regimens are preferred.