Pott Disease (Tuberculous [TB] Spondylitis) Medication

Updated: Feb 18, 2022
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Medication Summary

A four-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 generally are chosen from among the first-line drugs, such as pyrazinamide, ethambutol, and streptomycin. (A three-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 a course of 6 months to 9 months, 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. [75, 76]


Antitubercular Agents

Class Summary

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


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 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 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.