Given the many effective medications available today, the chances are great that a person with TB can be cured. It is important, however, for the person to understand the disease and to cooperate fully in the therapy program.
Both latent TB infection and active TB disease are treated with antibiotics. Treatment lasts at least six months because antibiotics work only when the bacteria are actively dividing, and the bacteria that cause TB grow very slowly. While latent TB infection can be treated with only one antibiotic, active TB disease is treated with several antibiotics at one time, to decrease the chances that the bacteria will evolve resistance to the drugs. Active TB disease must be treated aggressively, and patients may have to start treatment with a hospital stay, to keep them from spreading the disease. After a few weeks, they will feel better and will no longer be infectious.
The biggest danger in TB treatment is that the patient will not take antibiotics on schedule. This gives the bacteria the opportunity to develop resistance to the drugs, rebound, and become much more difficult to treat. Therefore, it is crucial to take all of your drugs as instructed. Most treatment programs require that a healthcare professional watch you take every dose.
Your doctor may monitor you during treatment with blood tests to check your liver, sputum tests to see if the bacteria are susceptible to the antibiotics you are taking, and chest X-rays to look for signs of disease.
Extrapulmonary TB is active TB disease in any part of the body other than the lungs (for example, the kidney, spine, brain, or lymph nodes). Treatment for extrapulmonary disease is basically the same as for TB in the lungs except that TB involving the brain or bones is treated longer.
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Latent TB Infection
Treatment for latent TB infection is usually a single antibiotic for nine months. The goal of this treatment is to eliminate the bacteria from your body. A long treatment is required because antibiotics work only when the bacteria are actively dividing, and the bacteria that cause TB can rest without growing for long periods. This treatment is necessary to keep the latent TB infection from developing into active disease.
Isoniazid (INH) is the most commonly prescribed antibiotic for latent TB. INH can cause liver damage with long-term use, so your doctor may monitor your liver with blood tests over the months that you take the drug. You should avoid acetaminophen (Tylenol) and alcohol while taking INH, as these can also cause liver damage. (Symptoms of liver damage include nausea, vomiting, yellow discoloration of the eyes, fever, and diarrhea.) Some people who do not have a positive skin test take INH because their history of exposure to someone with active disease makes it likely that they have been infected.
Some drugs taken for other conditions increase the risk that a latent TB infection will become active; be sure to tell your doctor about all drugs that you are taking.
Active TB Disease
Immediate treatment with antibiotics is necessary to treat active TB disease. Since the advent of anti-TB medications in the 1940s, treatment of drug-susceptible TB (TB that is not drug-resistant) has become highly effective if administered and taken properly. Treatment no longer requires prolonged hospital stays. In most cases, a person with a new case of active TB can be treated at home. Others will enter the hospital in special rooms that minimize the chance of spreading the infection to other patients and staff, where they take medications until the disease is no longer infectious. When the patient is no longer infectious, he can leave the hospital and continue taking medication at home. Hospitalization may be a few weeks to several months depending on the severity of the disease and whether or not the patient has a safe place to live.
Since active TB is slow to respond completely to therapy, prescribed medications must be taken every day for a long time. This may be at least six months and, sometimes, a year or more. In most cases, a treatment program for drug-susceptible TB involves taking two to four medications. Your doctor may use the results of a sputum test to determine which antibiotics are most likely to be effective.
Some medications commonly used for active TB disease:
- Isoniazid (INH)
- Rifampin (RIF, Rifadin, or Rimactane)
- Pyrazinamide
- Ethambutol (Myambutol)
- Streptomycin
Some of these drugs can cause liver damage, so your doctor will monitor your liver with blood tests during the course of your treatment. You should avoid acetaminophen (Tylenol) and alcohol while having tuberculosis treatment, as these can also cause liver damage. Also, women should be aware that rifampin makes hormonal birth control methods (such as the pill, implants, and the patch) less effective. Ethambutol can affect eyesight, including visual acuity and color vision, and some patients on this drug will need regular eye tests.
If you are having trouble taking your medications for any reason—forgetfulness, uncomfortable side effects such as nausea, or anything else—talk to your doctor. He or she may be able to help.
You may be asked to take your antibiotics under the observation of your doctor or other healthcare professional. This method of administration is called directly observed therapy (DOT) is the preferred way to treat TB disease. Many health departments will arrange for a healthcare worker to meet you daily at home or at work for this purpose. This is because forgetting to take your medication, or failure to take your medication as prescribed, can lead to the life-threatening condition of multidrug-resistant TB (MDR TB). Treating MDR-TB requires long hospital stays and high doses of antibiotic medications that often have severe side effects.
Drug-Resistant Tuberculosis
In a small percentage of cases, the initial treatment does not go as planned. The medication chosen may not work for a particular infection, or the patient's body may not absorb the medications properly. Some patients fail to take the medications as instructed. In these cases, the bacteria that cause TB may become resistant to some or all of the medications. Some people have drug-resistant TB from the start, if they were infected by someone whose disease was caused by drug-resistant bacteria. People with HIV or AIDS and persons who have been treated previously are at higher risk of developing drug-resistant TB. While 100 years ago there were no drugs to cure TB, now for every TB drug, there is at least one strain of TB-causing bacteria resistant to it.
Drug-resistant TB is very difficult to treat and, in some cases, cannot be cured. It generally requires more and different medications for a longer period of treatment than drug-susceptible TB. A person with drug-resistant TB should be treated by a specialist with considerable experience in managing the disease. The medications used for drug-resistant tuberculosis include the injectable antibiotics capreomycin, kanamycin, and amikacin. The injectable drugs can cause hearing loss and balance problems. Sometimes, surgery is needed to remove areas of destroyed lung that contain germs that are inaccessible to antibiotics.
In addition to being difficult to treat, drug-resistant TB has the potential to be a major public health problem, as first-line treatments for TB become less useful.
There are various levels of drug-resistant tuberculosis. Multidrug-resistant TB (MDR-TB) is resistant to the first-line drugs rifampin and isoniazid, and may also be resistant to some other anti-TB drugs. Extensively drug-resistant tuberculosis (XDR-TB) is a newly described category of TB that is resistant to fluoroquinolone (a strong antibiotic like ciprofloxacin) and capreomycin, kanamycin, or amikacin, drugs currently used for MDR-TB. XDR-TB is extremely difficult to treat, but it is also rare. Misusing medications increases the risk of developing MDR-TB or XDR-TB. If drugs cannot be found to treat XDR-TB, it is fatal.
Tuberculosis With HIV/AIDS
Tuberculosis is particularly problematic among people with HIV and AIDS. Because these people have compromised immune systems, they are less likely to be able to keep a latent TB infection in check and more likely to have that infection progress rapidly to active TB disease. Some AIDS drugs reduce the effectiveness of drugs used to treat TB, so people with HIV who are being treated for TB may need to temporarily stop taking some of their antiretroviral drugs, adjust doses, or switch to other drugs. Drug-resistant TB can be deadly in people with HIV.
Last reviewed on 12/8/09
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