16. Guidelines for Treatment of Extrapulmonary Tuberculosis: Length of Therapy and Adjunctive Use of Corticosteroids

View in chapter → Adjunctive Use of Corticosteroid Therapy

Last Updated April 2026

Length of therapy 6 months
Corticosteroids Not recommended
Additional management considerations Pursue microbiologic proof of diagnosis prior to starting Rx
Length of therapy 6 to 9 months
Corticosteroids Not recommended
Additional management considerations Extend to 12 months if hardware is present
Length of therapy 6 to 9 months
Corticosteroids Not recommended for TB rx but may be indicated for cord compression
Additional management considerations Most spine infection can be cured with medical Rx. Surgery indicated for relief of cord compression, progressive disease despite medical therapy, instability of the spine.
Length of therapy 9 to 12 months
Corticosteroids Strongly recommended
Steroid Dosing for Adults Adults ≥ 25kg
12 mg/day of
dexamethasone x 3 weeks
followed by 3-week taper
Steroid Dosing for Children Children ≥ 25kg
12 mg/day of
dexamethasone x 3 weeks
followed by 3-week taper

Children < 25kg
8 mg/day of
dexamethasone for 3 weeks
followed by 3-week taper
Additional management considerations Most spine infection can be cured with medical Rx. Surgery indicated for relief of cord compression, progressive disease despite medical therapy, instability of the spine.
Length of therapy 9-12 months
Corticosteroids Strongly recommended
Steroid Dosing for Adults Adults ≥ 25kg
12 mg/day of dexamethasone x 3 weeks followed by 3-week taper
Steroid Dosing for Children Children ≥ 25kg
12 mg/day of dexamethasone x 3 weeks followed by 3-week taper

Children < 25kg
8 mg/day of dexamethasone for 3 weeks followed by 3-week taper
Additional management considerations Negative CSF culture or PCR test does NOT exclude this diagnosis

Follow CSF profile for response to therapy
Length of therapy 6 months
Corticosteroids Not recommended
Additional management considerations Empyema may require decortication
Length of therapy 6 months
Corticosteroids NO LONGER routinely RECOMMENDED
Additional management considerations Consider steroids for patients at highest risk of later constriction: large pericardial effusions high levels of inflammatory cells or markers in pericardial fluid those with early signs of constriction
Length of therapy 6 months
Corticosteroids Not recommended
Additional management considerations Obtain cultures from blood, urine and sputum in addition to clinically apparent sites of disease.
Length of therapy 6 months
Corticosteroids Not recommended
Additional management considerations
Length of therapy 6 months
Corticosteroids Not recommended
Additional management considerations

ALWAYS EVALUATE for concomitant pulmonary involvement with respiratory samples for smear and culture (regardless of chest imaging findings).

Based on CID 2016:63 (1 October) • Nahid et al