Answer to the Letter to the Editor of B. Garg et al. concerning "Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients" by Upadhyay M, et al. [Eur Spine J (2020) 29:1476–1482]

[摘要] The authors have presented a series of spinal tuberculosis cases with the objectives to assess drug sensitivity patterns in the Xpert MTB-positive spinal TB patients and to frame the guidelines for starting empirical anti-tubercular treatment at the earliest in cases with repeated negative or indeterminate culture results, in an unresponsive patient or places where standard culture and drug sensitivity testing (DST) facilities are not available [1]. Besides the primary drug resistance which is genetically determined, the acquired forms of drug resistance are contributed by the inadequate treatment without weight-adjusted drug dosage regimens, incomplete treatment with short-course chemotherapy without supervision and non-adherence of the patients. The authors do agree and urge the readers of this journal to be up to date with the most recent WHO guidelines [2] that suggest pyrazinamide (Z) as a ‘weakly bactericidal’ and should be considered an essential part of the intensive phase of anti-tubercular therapy not only in drug-susceptible but also in MDR cases [1, 2].