Several medicines are used to treat tuberculosis (TB). Treatment usually lasts at least six months.
If you are diagnosed with active pulmonary TB (TB that affects your lungs), you will probably be referred to a TB treatment team. This is a team of healthcare professionals with experience in treating TB.
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 public health doctor
- a TB nurse
- a public health nurse - 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 or who will be the point of contact between you and the rest of the team and will help co-ordinate your care.
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
After taking the medicine for at least two weeks, most people are no longer infectious. However, it is very important to take your medicine exactly as prescribed and to complete the whole course of antibiotics.
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.
Taking medication for six months is the most effective method of ensuring that both the active and dormant TB bacteria are killed. The active bacteria are responsible for causing your current TB infection, but the dormant bacteria could become active in the future, so must also be 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 and can be difficult to treat. See Tuberculosis - complications for more information about drug-resistant tuberculosis.
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 a 12-month course, rather than a six-month course.
If you have TB that affects your brain or heart, you may also be prescribed a corticosteroid, such as prednisolone, to take at the same time as your antibiotics. You will need to take the corticosteroid for several weeks.
As with pulmonary TB, it is very important to take your medicines exactly as prescribed and to finish the course.
Latent TB is where you have been infected with the TB bacteria but you do not have any symptoms. Treatment for latent TB is usually recommended for:
- people who are 35 years of age or under
- people with HIV, regardless of their age
- people who are on immunosuppressive therapy
- 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 other people who are not on the list above and who have latent tuberculosis. This is because the risk of liver damage increases with age and the risks of treatment outweigh the benefits for some people.
In some cases, treatment for latent TB may be recommended for people taking immunosuppressant medication. This medication suppresses the immune system (the body's natural defence against illness and infection) and can make active TB more likely. This could include people taking long-term corticosteroids or people receiving chemotherapy.
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 may also be tested.
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 38C (100.4F) 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
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.
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.