How Tuberculosis (TB) Is Treated

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Latent and active forms of tuberculosis (TB) require treatment with antibiotics, such as isoniazid and rifampin. The dosage and duration of your prescription will vary depending on your case and overall health, but you should expect to take your medication(s) for several months. Tuberculosis is sometimes resistant to antibiotics, so it is possible that your infection may not be fully eradicated, especially if instructions are not followed to the letter.

 Fortunately, most people who are infected with TB never get sick. They harbor the bacteria, but they don’t have symptoms and are not contagious. 

Prescriptions

Prescription antibiotics are the only means of treating tuberculosis, but the necessary course is not like one you might have been prescribed for another reason. Antibiotic treatment for tuberculosis is tailored to an individual's disease state and general health, but will always be several months in duration. In addition, you may be required to take several antibiotics simultaneously.

Latent TB

While latent TB cannot be spread to others, those with it are at risk of developing an active infection that is both symptomatic and contagious. About 3 percent to 5 percent of people with latent TB develop active TB in the first year after a positive test; about 5 percent to 15 percent develop it later.

Receiving treatment for a latent TB infection significantly reduces the likelihood of this.

Your doctor will likely put you on a six- to nine-month course of the oral antibiotic isoniazid. An alternative treatment is three months of rifampin, another oral antibiotic.

Active TB

Active TB is usually treated with a combination of four medications for six to eight weeks, followed by two drugs for a total duration of six to nine months.

 In addition to isoniazid and rifampin, the regimen includes ethambutol and pyrazinamide. 

Dosages of these drugs will be determined by any other health issues you may have and other medications you may be taking. Patients taking antiviral medications for HIV, for example, may need to switch medications to avoid dangerous side effects. The duration of treatment may also be altered based on these factors. 

Side Effects

These TB treatments can have side effects, which you might experience depending on the drugs you are taking and your sensitivity to them. According to the American Lung Association, side effects can include the following. Be sure to tell your doctor if you experience these or anything else unusual:

  • Lack of appetite
  • Nausea
  • Vomiting
  • Yellowing of the skin or eyes
  • Fever for three or more days
  • Abdominal pain
  • Tingling fingers or toes
  • Skin rash
  • Easy bleeding or bruising
  • Aching joints
  • Dizziness
  • Tingling or numbness around the mouth
  • Blurred or changed vision
  • Ringing in the ears
  • Hearing loss

Challenges

You will likely have periodic tests to see if your medicine is working. These may include blood, phlegm, or urine tests, as well as chest X-rays. The need for this surprises many. 

When an antibiotic fails to kill all of the bacteria it’s targeting, the remaining bacteria can become resistant to that particular drug.

This can happen with the treatment of any bacterial disease, but it's especially an issue with tuberculosis. If, through these tests, your doctor notes that your infection is not improving as hoped, your dosage, treatment duration, or even the drug(s) being used may be changed.

Resistance is particularly worrisome when TB is not responsive to both isoniazid and rifampin, the two drugs most commonly used to control the disease. When this happens, your case is dubbed multi-drug resistant TB (MDR TB)

To further complicate matters, some strains of TB are not only resistant to first-line antibiotics, but the next-choice options used when this is the case, such as fluoroquinolones and the injectable medications amikacin, kanamycin, and capreomycin.

Two other drugs, bedaquiline and linezolid, are being looked into as add-on therapy to the current drug-resistant combination treatment.

When TB is resistant to all medications, it is called extremely drug-resistant TB (XDR TB).

Drug-resistant TB can occur when a patient does not complete the full course of treatment (either they miss doses or stop the course too early), or when health care providers prescribe the wrong dose or duration of an antibiotic. Resistance is also common in people with HIV.  MDR TB and XDR TB are especially prevalent in countries where drugs are often of poor quality or not available at all. 

If you are having trouble taking your medications as directed, tell your healthcare provider. 

Preventing Transmission

If you have active TB, you will need to take some precautions during treatment to prevent transmitting the disease:

  • Stay home until your healthcare provider says you may return to school or work.
  • Avoid interacting with other people as much as possible until your doctor says you can have visitors. Wear a surgical mask when leaving the home or having visitors.
  • Put all used tissues in a closed trash bag before disposing of them.
  • Do not share dishes or a toothbrush with anyone else; wash your hands frequently.
  • Always follow your doctor’s instructions regarding how to take your medicine to the letter. 

You will be asked to follow these precautions until it is clear you are responding to treatment and no longer coughing. After a week or two of treatment with the correct antibiotics, most people are less likely to spread the disease. If you live or work with people who are at high risk (such as young children or people with AIDS), you may need to have your sputum examined to determine when the danger of spreading the infection has passed.

Most infected people do not need to be hospitalized for treatment these days. Hospitalization is usually only recommended for people who have another serious disease, live in close, crowded situations, or do not have an appropriate place to go (the homeless, for example).

A hospitalized TB patient may be discharged to their home while still infectious, provided no one in the person's home is at high risk for active TB (sick, elderly, or children). 

People who find it hard to remember to take their pills are often candidates for directly observed therapy (DOT), in which a healthcare worker dispenses the medications daily and watches the patient take them.

If you live or work with someone with active disease or have a weakened immune system, talk to your doctor about getting a TB skin test.

Finally, while there is a vaccine to prevent TB, called bacille Calmette-Guerin (BCG), it is rarely used in the United States. It is sometimes recommended for people who work in hospitals or for children who are continually exposed to adults with active TB or multi-drug resistant TB, but is not standard practice. 

Sources:

Centers for Disease Control and Prevention. Division of Tuberculosis Elimination. Tuberculosis (TB)

Centers for Disease Control and Prevention. Drug-Resistant TB. https://www.cdc.gov/tb/topic/drtb/default.htm

Centers for Disease Control and Prevention. Staying on Track with Tuberculosis Medicine. https://www.cdc.gov/tb/publications/pamphlets/tb_trtmnt.pdf 

Centers for Disease Control and Prevention. Treatment for TB Disease. https://www.cdc.gov/tb/topic/treatment/tbdisease.htm

Johns Hopkins Health Library. https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/infectious_diseases/tuberculosis_tb_85,P00654

Merck Manual, Consumer Version. https://www.merckmanuals.com/home/infections/tuberculosis-and-leprosy/tuberculosis-tb#v785390

World Health Organization. Tuberculosis. http://www.who.int/tb/en/