treatment

Treatments and drugs

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. Normally, you take antibiotics for at least six to nine months to destroy the TB bacteria. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.

Several promising new TB drugs are in development, and some may become available within the next 10 years.

Treating TB infection (latent TB)
If tests show that you have TB infection but not active disease, your doctor may recommend preventive drug therapy to destroy bacteria that might become active in the future. You're likely to receive a daily or twice-a-week dose of the TB medication isoniazid. For treatment to be effective, you usually take isoniazid for nine months. Long-term use of isoniazid can cause side effects, including the life-threatening liver disease hepatitis. For this reason, your doctor will monitor you closely while you're taking isoniazid. During treatment, avoid using acetaminophen (Tylenol, others) and avoid or limit alcohol use. Both increase your risk of liver damage.

Treating active TB disease
If you're diagnosed with active TB, you're likely to begin taking four medications — isoniazid, rifampin (Rifadin), ethambutol (Myambutol) and pyrazinamide. This regimen may change if tests later show some of these drugs to be ineffective. Even so, you'll continue to take several medications. Depending on the severity of your disease and whether the bacteria are drug-resistant, one or two of the four drugs may be stopped after a few months. You may be hospitalized for the first two weeks of therapy or until tests show that you're no longer contagious.

Sometimes the drugs may be combined in a single tablet such as Rifater, which contains isoniazid, rifampin and pyrazinamide. This makes your treatment less complicated while ensuring that you get all the drugs needed to completely destroy TB bacteria. Another drug that may make treatment easier is rifapentine (Priftin), which is taken just once a week during the last four months of therapy, in combination with other drugs.

Medication side effects
Side effects of TB drugs aren't common, but can be serious when they do occur. All TB medications can be highly toxic to your liver. Rifampin can also cause severe flu-like signs and symptoms — fever, chills, muscle pain, nausea and vomiting. When taking these medications, call your doctor immediately if you experience any of the following:

• Nausea or vomiting
• Loss of appetite
• A yellow color to your skin (jaundice)
• Dark urine
• A fever that lasts three or more days and has no obvious cause
• Tenderness or soreness in your abdomen
• Blurred vision or colorblindness

Treating drug-resistant TB
Multidrug-resistant TB (MDR TB) can't be cured by the two major TB drugs, isoniazid and rifampin. Extensive drug-resistant TB (XDR TB) is resistant to those drugs as well as three or more of the second line TB drugs. Treating these resistant forms of TB is far more costly than is treating nonresistant TB.

Treatment of drug-resistant TB requires taking a "cocktail" of at least four drugs, including first line medications that are still effective and several second line medications, for 18 months to two years or longer. Even with treatment, many people with these types of TB may not survive. If treatment is successful, you may need surgery to remove areas of persistent infection or repair lung damage.

Treating children and pregnant women
Treating TB in children is largely the same as treating adults, except that ethambutol is not used for young children because of the possible side effect of vision problems. Instead of ethambutol, children may take streptomycin.

For pregnant women with active TB, initial treatment often involves three drugs — isoniazid, rifampin and ethambutol. Pyrazinamide isn't recommended because its effect on the unborn baby isn't known. Some second line TB medications also aren't recommended.

Completing treatment is essential
After a few weeks, you won't be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat. Drug-resistant strains of TB can quickly become fatal, especially if your immune system is impaired.

In an effort to help people stick with their treatment, a program called directly observed therapy (DOT) is recommended. In this approach, a nurse or other health care professional administers your medication so that you don't have to remember to take it on your own. Sometimes clinics provide incentives, such as food coupons or transportation, for people to show up for their appointments.