Role of Extended Anti-Tubercular Therapy Course Duration in Slowly Responsive or Non-Responsive Tubercular Cervical Lymphadenopathy

Abstract

Introduction: Tubercular cervical lymphadenopathy (TCL) remains a significant health concern, particularly in developing countries. The effectiveness of extended anti-tubercular therapy in slowly responsive or non-responsive TCL cases is a subject of ongoing debate. This study aimed to assess the role of extended anti-tubercular therapy course duration in such cases and to explore the need for alternative treatment strategies. Methods: This retrospective study was conducted over a period of 4 years, from January 2019 to January 2023, at the Department of ENT & Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh. The initial sample size of 189 TCL patients was narrowed down to 125 slow or non-responsive patients after 6 months of standard treatment. Various characteristics such as swelling type, swelling size, and swollen node were analyzed, and the response rate to standard medication was assessed. Result: The study revealed that 90.40% had swelling sizes of 3 cm or less, with limited changes in nodal size over time, and only 16.80% reaching a nodal size of less than 10 mm after a year. The response rate to medication was 33.86% after 6 months and 46.56% after a year, with 19.58% still showing a slow response. The swelling size shifted from 51.32% being less than or equal to 3 cm initially to 70.27% being greater than 3 cm after a year, suggesting that continuing medication might not be effective for a significant number of non/slow-responsive TCL cases. Conclusion: The findings of this study highlight the limitations of extended standard treatment for TCL and emphasize the need for personalized approaches, possibly including surgical intervention. The evidence presented calls for further research to explore alternative strategies and a reevaluation of current treatment guidelines, prioritizing patient outcomes and responsiveness to therapy.