Efficacy of alternate day Directly Observed Treatment Short-course (DOTS) in skeletal tuberculosis – A retrospective study

Abstract Objective To assess the efficacy of alternate day (thrice a week) Directly Observed Treatment Short-course (DOTS) regimen spanning six to nine months in providing sustained cure for skeletal tuberculosis (TB) under programmatic conditions. Design Retrospective cohort study. Setting An urban district tuberculosis centre in India under the Revised National Tuberculosis Programme. Participants A cohort of 218 patients treated with alternate day DOTS regimen for skeletal TB between 2007 and 2012. Methods All patients with the diagnosis of skeletal TB registered between 2007 and 2012 who successfully completed treatment were followed up for evidence of disease recurrence or relapse using structured interviews conducted between August 2013 and October 2015 after ensuring a minimum follow up of two years. Results Of the 200 patients eligible for follow up in this study, 117 (58.5%) had a minimum follow up of two years. The remaining 83 cases could not be traced. 105 (89.7%) of these 117 patients were symptom free for two years or more after the completion of treatment. There were four cases who had a relapse of the disease within two years of completion of treatment. Eight cases were administered further ATT soon after the completion of treatment under DOTS. Conclusions This study confirms the efficacy of the alternate day DOTS regimen in successfully treating all forms of skeletal TB, including spinal TB, with a success rate of 89.7%.