Drug treatment of multidrug-resistant osteoarticular tuberculosis: a systematic literature review

OBJECTIVE: To review the literature in order to determine the best treatment options for multidrug-resistant tuberculosis (MDR-TB) of the skeletal system. METHODS: We searched the PubMed database for all case reports of osteoarticular MDR-TB that provided information on drug treatment and clinical outcome. RESULTS: We identified six cases with spinal MDR-TB and seven with extraspinal MDR-TB and reviewed their susceptibility tests, treatments administered, surgical treatments, and clinical outcomes. All patients had a successful clinical outcome (either cured or improved) except one who died due to septicemia. One patient with spinal MDR-TB and four patients with extraspinal MDR-TB had a successful outcome with medical treatment alone. Two patients who received treatment for a shorter time or with fewer drugs than recommended were cured with the addition of surgery. CONCLUSIONS: Osteoarticular MDR-TB is very infrequently reported in the literature. The few cases reviewed suggest that it is possible to achieve a good outcome with second-line anti-tuberculous drugs, and that surgery might be useful for cases in which an optimized medical treatment is not possible.