Treating tuberculosis

Treatment for tuberculosis (TB) depends on which type you have, although a long course of antibiotics is most often used.

While TB is a serious condition that can be fatal if left untreated, deaths are rare if treatment is completed.

For most people, hospital admission during treatment is not necessary.

Pulmonary TB

If you are diagnosed with active pulmonary TB (TB that affects your lungs and causes symptoms), you will be referred to a specialist TB treatment team. This is a team of healthcare professionals with experience in treating TB.

Treatment team

Your TB treatment team may include: 

• a respiratory physician – a doctor who specialises in conditions that affect the lungs and breathing
• an infectious disease specialist 
• a TB nurse 
• a health visitor – a qualified nurse with extra training who helps families with babies and young children to stay healthy
• your GP
• a paediatrician (if necessary) – a doctor who specialises in conditions that affect children 

It is also likely that you will be assigned a key worker. This is usually a nurse, health visitor or social care support worker who will be the point of contact between you and the rest of the team and will help co-ordinate your care.

Antibiotics

Pulmonary TB is treated using a six-month course of a combination of antibiotics. The usual course of treatment is:

• two antibiotics – isoniazid and rifampicin – every day for six months 
• two additional antibiotics – pyrazinamide and ethambutol – every day for the first two months

However, you may only need to take these antibiotics three times a week if you need supervision.

It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB.

After taking the medicine for two weeks, most people are no longer infectious and feel much better. However, it is important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics.

Taking medication for six months is the most effective method of ensuring that the TB bacteria are killed. If you stop taking your antibiotics before you complete the course or if you skip a dose, the TB infection may become resistant to the antibiotics. This is potentially serious, as it can be difficult to treat and will require a longer course of treatment.

If treatment is completed correctly, you should not need any further checks by a TB specialist afterwards. However, you may be given advice about spotting signs that the illness has returned, although this is rare.

In rare cases, TB can be fatal even with treatment. Death can occur if the lungs become too damaged to work properly.

Extrapulmonary TB

Extrapulmonary TB (TB that occurs outside the lungs) can be treated using the same combination of antibiotics as those used to treat pulmonary TB. However, you may need to take them for 12 months.

If you have TB that affects your brain, you may also be prescribed a corticosteroid, such as prednisolone, for several weeks to take at the same time as your antibiotics. This will help reduce any swelling in the affected areas.

As with pulmonary TB, it is important to take your medicines exactly as prescribed and to finish the course.

Latent TB

Latent TB is where you have been infected with the TB bacteria but do not have any symptoms of active disease. Treatment for latent TB is usually recommended for:

• people 35 years of age or under 
• people with HIV, regardless of their age
• healthcare workers, regardless of their age 
• people with evidence of scarring caused by TB, as shown on a chest X-ray, but who were never treated 

Treatment is not recommended for people who have latent tuberculosis and are over 35 years of age (and do not have HIV and are not healthcare workers). This is because the risk of liver damage increases with age and the risks of treatment outweigh the benefits for some people.

Latent TB is also not always treated if it is suspected to be drug resistant. If this is the case, you may be regularly monitored to check the infection does not become active.

In some cases, treatment for latent TB may be recommended for people requiring immunosuppressant medication. This medication suppresses the immune system (the body’s natural defence against illness and infection) and can allow latent TB to develop into an active form of the disease. This may include people taking long-term corticosteroids or people receiving chemotherapy.

In these cases, the TB infection should be treated before immunosuppressant medication begins.

Treatment for latent TB involves either taking a combination of rifampicin and isoniazid for three months, or isoniazid on its own for six months.

Side effects of treatment

Rifampicin can reduce the effectiveness of some types of contraception, such as the combined contraceptive pill. Use an alternative method of contraception, such as condoms, while taking rifampicin.

In rare cases, these antibiotics can cause damage to the liver or the eyes, which can be serious. Therefore, your liver function may be tested before you begin treatment. If you are going to be treated with ethambutol, your vision should also be tested at the beginning of the course of treatment.

Contact your TB treatment team immediately if you have any of the following symptoms:

• feeling sick or being sick 
• yellowing of your skin (jaundice) and darkening of your urine
• unexplained fever – a temperature of 38ºC (100.4ºF) or above
• tingling or numbness in your hands or feet
• skin rash or itchy skin
• changes to your vision, such as blurred vision or colour blindness

See medicines information for tuberculosis for more information about the side effects of your medication.

Supervised treatment

Sometimes people find it difficult to take their medication every day. If this affects you, your treatment team can work with you to find a solution. Usually, you will be asked to join a programme of “directly observed therapy”.

This can include supervised treatment, which will involve regular contact with your treatment team (daily or three times a week) to support you taking your medication. This can take place in your home, the treatment clinic or somewhere else more convenient.

Antibiotic-resistant tuberculosis (TB)

Like most bacteria, bacteria that cause TB can develop a resistance to antibiotics. This means the medicines can no longer kill the bacteria they are meant to fight.

Tuberculosis (TB) that develops a resistance to one type of antibiotic is not usually a concern because alternative antibiotics are available. In 2011, more than eight out of 100 cases of TB were resistant to at least one type of antibiotic normally used to treat the condition. 

However, in a number of cases:

• TB develops a resistance to two antibiotics – this is known as multi-drug resistant tuberculosis (MDR-TB) 
• TB develops a resistance to three or more antibiotics – this is known as extensively drug resistant tuberculosis (XDR-TB)

In 2011, almost two out of every 100 TB cases were resistant to at least two antibiotics. 

Both MDR-TB and XDR-TB will usually require treatment for at least 18 months using a combination of different antibiotics. As these conditions are difficult to treat, you may be referred to a specialist TB clinic for treatment and monitoring.

Preventing the spread of infection

If you are diagnosed with pulmonary tuberculosis (TB), which affects the lungs, you will be contagious up to about two to three weeks into your course of treatment.

You will not normally need to be isolated during this time, but it is important to take some basic precautions to stop TB spreading to your family and friends. These precautions are:

• stay away from work, school or college until your TB treatment team advises you it is safe to return 
• always cover your mouth when coughing, sneezing or laughing 
• carefully dispose of any used tissues in a sealed plastic bag 
• open windows when possible to ensure a good supply of fresh air 
• do not sleep in the same room as other people because you could cough or sneeze in your sleep without realising it