Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
This question is about medicine duration for bone TB treatment. I was having left hip pain, and MRI showed mild synovitis in the left hip one year ago. The medication was initially started suspecting bone TB. There was a repeat MRI after four months of completion of medicine and everything was fine in the hip. I took Akurit 4 for two months and Akurit 3 for 10 months. The dosage of medicine was: four tablets of Akurit 4 and half a tablet of Benadon 40, four tablets of Akurit 3 and half a tablet of Benadon 40. There was another MRI after one-year completion of medicine and everything is fine in the hip. The hip pain reduced gradually during the last year. There was little pain and I was using a hip support belt, and walking stick for the staircase at that time. I have stopped using a hip belt, and walking stick for the last two weeks. The pain is hardly 2 % to 3 % while walking a little more or going on the staircase now. The value of ESR, and CRP during 12 months of medication was; before starting medicine: ESR - 12, CRP - 0.27. Six months after medication: ESR -10, CRP - 0.46. Ten months after medication: ESR - 5, CRP - 0.26. This is to mention I have undergone six months of TB medication for pulmonary tuberculosis three years before bone TB was detected. The issue now is whether to stop TB medicine or continue the medicine for another six months. One doctor suggests stopping TB medicine since symptoms disappeared. Another family doctor suggests continuing medicine for another six months to avoid re-occurrence. I have attached three MRI reports and a recent LFT report for your reference. There are some queries that I have in this regard. Whether to continue TB medicine for 18 months or stop now? Does persistence of pain and remaining pain of 2 % to 3 % indicate some infection? Whether taking medicine for 18 months reduces the re-occurrence chance of bone TB? What should be done if bone TB happens again? Whether the medicine dosage: four tablets of Akurit 3 and half a tablet of Benadon 40 for the next six months is fine? What problem could happen if the medicine is continued for 18 months? Looking forward to your reply.
Hello,
Welcome to icliniq.com.
The answers to your questions are as follows:
1) Duration of treatment is nine months and you have exceeded that, the only need to extend treatment is if the symptoms or if blood parameters are raised. In your case, symptoms, CRP, and ESR are normal.
2) No if the symptoms are minimal 2 to 3 % then, that is normal. You may be more aware of symptoms as you fixated on them. The important thing is that your symptoms should not worsen with activity, and there should be no night pain.
3) No increased duration does not help with recurrent infections instead increases the chances of multi-drug resistance organisms. You should concentrate on your immunity by sleeping well and not smoking or drinking, eating healthy, eating nuts, and avoiding pollution and crowded closed spaces.
4) No need to extend treatment.
6) As alluded there is no need for extended treatment, it does not help your liver, increases the chances of MDR (multi-drug resistant)TB, and gives you no protection against further infections.
Patient's Query
Hi doctor,
Thank you so much for the detailed reply. There are some of the follow-up queries I have. You have mentioned that "symptoms should not worsen with activity." I feel some pain if I walk more distance. I use the staircase from the first floor to the ground floor five times daily. This use of a staircase is causing little pain. Does it mean symptoms are worsening with activity? How much time will it take for a complete reduction of hip pain, or some pain will always be there? Is there any need for periodic check-ups to ensure TB infection is not recurring? How many times can a TB patient have a re-occurrence of TB? Can I survive if there is another re-occurrence of TB by medicine?
Thank you.
Hello,
Welcome back to icliniq.com.
Pain during activity is not a major issue. Complete resolution is a misnomer as you will have flare-ups of symptoms when weather changes or after a period of intense or unaccustomed activity and this will gradually fade away. No, it will depend on your symptoms and your body's ability to keep its immunity strong. A good night's sleep is very important, regular exercise, nuts in your diet, avoid junk foods, no smoking, maintain vitamin D levels.
Thank you.
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Orthopedician and Traumatology
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