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Spinal Tuberculosis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesSpinal TuberculosisRACP Adult Medicine

A 72-year-old woman on long-term prednisolone for polymyalgia rheumatica presents with progressively worsening back pain over 4 weeks. MRI spine shows T8 vertebral body collapse with enhancement. ESR is 85 mm/hr and CRP is 60 mg/L. Blood cultures are negative. CT-guided biopsy grows Mycobacterium tuberculosis. What is the appropriate treatment duration?

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Correct answer: D — 12 months total (2HRZE/10HR)

Skeletal TB (Pott's disease/spinal TB) requires a prolonged treatment course. Australian and international guidelines recommend extending treatment to 9–12 months (2 months intensive phase HRZE followed by 7–10 months continuation phase HR). The extended duration is due to poor drug penetration into bone and the immunosuppressed state. Surgical intervention is reserved for neurological compromise, instability, or failure to respond to medical therapy.

Reference: NTAC – 2022 – National TB Guidelines; eTG – 2025 – Antibiotic Guidelines