How Tuberculosis (TB) Is Treated

Latent and active forms of tuberculosis (TB) require treatment with antibiotics, such as isoniazid and rifampin. While the dosage and duration of your prescriptions will vary depending on your case and overall health, you should expect to take your medication(s) for several months. Tuberculosis is sometimes resistant to antibiotics, so it is possible that you may need second or third-line treatments.  

Prescriptions

Prescription antibiotics are the only means of treating tuberculosis, and they are used for several months. Antibiotic treatment for tuberculosis is tailored to an individual's disease state and general health. And you may be required to take several antibiotics simultaneously.

Latent TB

While latent TB cannot be spread to others, there is a risk of developing an active infection that is both symptomatic and contagious. There is a 5% chance of converting/re-activating from latent TB infection (LTBI) to active TB disease in the first two years after exposure and acquiring LTBI.

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

The preferred regimens for LTBI treatment can include:

• Weekly doses of isoniazid and rifapentine for a total of 12 doses (three months of treatment)
• Daily rifampin for four months

Daily isoniazid for six to nine months is an alternative regimen that carries a higher risk of hepatotoxicity and a lower chance of treatment completion.

Active TB

Active TB is usually treated with a combination of different medications over the course of four, six, or nine months—depending on the regimen.

The four-month TB treatment regimen, which is recommended for those ages 12 years and older, consists of eight weeks of daily treatment with rifapentine, isoniazid, pyrazinamide, and moxifloxacin. This is then followed by nine weeks of daily treatment with rifapentine, isoniazid, and moxifloxacin.

The six- and nine-month TB treatment regimens consist of an intensive phase of two months of isoniazid, rifampin, ethambutol, and pyrazinamide. This is then followed by a continuation phase of either four or seven months of isoniazid and rifampicin.

Dosages of these drugs will be determined with consideration of other health issues you may have and other medications you may be taking. If you're taking antiviral medications for HIV, for example, you may need to switch medications to avoid dangerous side effects. The duration of treatment may also be influenced by these factors. 

Side Effects

The medications used for treating TB can have side effects, which can depend on the specific drugs you are taking and your sensitivity to them.

According to the American Lung Association, side effects TB medications can include the following:

• 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

Be sure to tell your healthcare provider if you experience these side effects or any other new symptoms while taking the treatments.

Tuberculosis Doctor Discussion Guide

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Challenges

During your treatment, 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. 

Bacteria can become resistant to certain antibiotics. This can happen with any bacterial disease, especially with tuberculosis. If your healthcare provider notes that your infection is not improving, they may change your dosage, treatment duration, or the drug(s) you are prescribed.

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, the case is dubbed multi-drug resistant TB (MDR TB). 

To further complicate matters, some strains of TB are resistant to first-line antibiotics, as well as next-choice options, such as fluoroquinolones and the injectable medications amikacin, kanamycin, and capreomycin. Two other drugs, bedaquiline and linezolid, are being investigated as add-on therapy to the current drug-resistant combination treatment.

Extremely drug-resistant TB (XDR TB) is defined as TB that is resistant to isoniazid and rifampin and preferred second line agents inclusive of the fluoroquinolones, as well as at least one of three injectable drugs (i.e., amikacin, kanamycin, or capreomycin).

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. Most infected people do not need to be hospitalized for treatment.

Precautions include:

• 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 healthcare provider 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 healthcare provider's instructions regarding your medicine to the letter. 

You will be asked to follow these precautions until it is clear that 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 the risk of spreading the infection.

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). 

Most patients with pulmonary tuberculosis are recommended to receive directly observed therapy (DOT), in which a healthcare worker dispenses the medications daily and watches the patient take them. This can be provided via phone or video platforms.

If you live or work with someone who has an active disease or a weakened immune system, talk to your healthcare provider. They may recommend that you get a blood test called interferon-gamma release assay (IGRAs) to assess for LTBI or 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 it is not standard practice.