Tuberculosis (TB): Treatment Overview

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Treatment Overview

Doctors treat tuberculosis (TB) with antibiotics to kill the TB bacteria. These medications are given to everyone who has TB, including infants, children, pregnant women, and people who have a weakened immune system.

People who have TB that cannot be spread to others (latent TB) also receive treatment to prevent the infection from becoming active.

When treating active TB, health experts recommend:⁶

• Using more than one medication to prevent multidrug-resistant TB. The standard treatment begins with four medications given for 2 months.
• Continuing treatment for 4 to 9 months or longer if necessary. The number of medicines used during this time depends on the results of sensitivity testing.
• Using directly observed therapy (DOT). This means visits with a health professional who watches you every time you take your medication. A cure for TB requires you to take all doses of the antibiotics. These visits ensure that people follow medication instructions, which is helpful because of the long treatment course for TB.
• Trying a different combination of medications if the treatment is not working because of drug resistance (when tests show that TB-causing bacteria are still active).
• Using different treatment programs for people infected with the human immunodeficiency virus (HIV), people infected with TB bacteria that are resistant to one or more medicines, pregnant women, and children.

When treating latent TB, experts recommend:¹

• Using one medicine to kill the TB bacteria and prevent active TB. The standard treatment is isoniazid taken for 9 months. For people who cannot take isoniazid for 9 months, sometimes a 6-month treatment program is done.
• Treatment with rifampin for 4 months. This is an acceptable alternate treatment, especially for people who have been exposed to bacteria that is resistant to isoniazid.

Treatment for extrapulmonary tuberculosis

Treatment for tuberculosis outside the lungs (extrapulmonary TB) usually is the same as for pulmonary TB. You may need other medications or forms of treatment depending on where the infection is in the body and whether complications develop.

You may need treatment in a hospital if you have:

• Severe symptoms.
• TB that is resistant to multiple-drug therapy.

What To Think About

For active TB, there are different treatment recommendations for people with HIV and TB, people with drug-resistant TB, children with active TB, and pregnant women with active TB.

If you miss doses of medication or you stop treatment too soon, your treatment may go on longer or you may have to start over. This can also cause the infection to get worse or lead to antibiotic-resistant infections that are much harder to treat.

A cure for TB requires you to take all doses of the antibiotics. This may mean daily visits with a health professional who watches you take the medication. This is known as directly observed therapy (DOT).

Taking all of the medications is especially important for people who have an impaired immune system. They may be at an increased risk for a relapse because the original TB infection was never cured.

Relapses usually occur within 6 to 12 months after treatment. Treatment for relapse is based on the severity of the disease and which medications were used during the first treatment.

Doctors also use medication treatment to prevent people with a latent TB infection from developing active TB. Health experts recommend this for people who have a positive tuberculin skin test but no symptoms of TB. Treatment is especially important for people with latent TB who:

• Have HIV infection or AIDS.
• Have close contact with a person who has active TB.
• Have a chest X-ray that suggests a TB infection, but have not had a complete course of treatment.
• Inject illegal drugs.
• Have a medical condition or take medicine that weakens the immune system.
• Have had a tuberculin skin test within the past 2 years that was negative but now the skin test is showing a TB infection (positive).

Last updated:	May 16, 2007
Author:	Maria G. Essig, MS, ELS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Alfred A. Lardizabal, MD - Pulmonology and Critical Care Medicine/Tuberculosis
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC