Tuberculosis - Treatment

Authored by Dr Laurence Knott, 05 Jul 2017

Reviewed by:
Dr Adrian Bonsall, 05 Jul 2017

'Normal' antibiotics do not kill tuberculosis (TB) germs (bacteria). You need to take a combination of special antibiotics for several months. Standard treatment in the UK is usually for six months. First, it involves a combination of four antibiotics that you take for two months. These are isoniazid, rifampicin, pyrazinamide and ethambutol. This is followed by continuing with rifampicin and isoniazid for a further four months. The treatment plan may be different, depending on what type of TB you have and which part of the body is affected.

If treatment fails, it is often due to not taking medication properly and regularly. It is vital that you follow the instructions about medication. Even if you feel much better in a few weeks (as many people do), you must finish the full course of treatment.

Attending follow-up appointments is important. This is to check that your TB is responding to the treatment and to check for any side-effects of treatment.

Why is important to take the full course of treatment?

The TB bacteria in the body are more difficult to get rid of than 'ordinary' bacteria. Only a long course of treatment can fully clear TB bacteria from the body. If you do not take the full treatment then the following problems often occur:

  • You may remain infectious to other people.
  • You may not be cured. You may feel better at first but some TB bacteria may stay in your body. These can reactivate at a later time and make you very ill.
  • If the original infection is only partly treated, the bacteria can become resistant to antibiotics (explained below). The TB then becomes more difficult to treat.

The medicines used to treat TB have a good safety record. Sometimes side-effects occur. If one does, see a doctor urgently, so that your treatment can be adjusted or changed to a different antibiotic.

You can read the leaflet which comes with the medicine packet for a list of possible side-effects. Some important things to know are:

  • Liver problems. You will have blood tests to monitor your liver function. It is common to get mildly abnormal liver tests when taking TB treatment. This doesn't always mean that the treatment needs to be changed. Symptoms of liver problems are:
    • A yellow tinge to the skin and eyes (jaundice).
    • A high temperature (fever).
    • Feeling sick (nausea).
    • Itching.
    • Feeling generally more unwell.
    If you have any of these, stop the tablets and see a doctor urgently.
  • Vision changes (if taking ethambutol). Early symptoms are slight loss of vision or loss of colour vision. If you notice any loss of vision, stop the ethambutol and see a doctor urgently. Vision can recover fully if the ethambutol is stopped quickly. You will need to have a sight test before you start taking ethambutol.
  • Nerve problems (neuropathy) if taking isoniazid. This can cause numbness and tingling in the arms and legs. It can be helped by taking an extra vitamin (pyridoxine) - which is sometimes prescribed together with the isoniazid.
  • Rifampicin makes your tears and urine orange-coloured. This is normal.
  • TB medication can affect other medicines, including the contraceptive pill. Tell the TB clinic about all your medication, so that it can be taken into account when deciding about treatment.

Tests and treatment for TB are free to everyone in the UK - even if you are not a UK resident.

Your doctor will refer you for tests if he or she suspects that you have TB. This is usually to a local TB or chest clinic. In addition, there are also mobile X-ray units in London, which provide chest X-rays as an initial test for TB. The mobile units visit prisons, shelters for the homeless, and refugee centres.

Treatment is normally from a TB clinic. Most hospitals in the UK have a chest clinic or TB clinic with staff experienced in treating TB. Your GP can help with prescriptions.

Most people with TB can have treatment at home. Hospital admission is not usually necessary unless:

  • You are quite ill.
  • The treatment is complicated for some reason.
  • You have difficult circumstances such as homelessness.

Some people find it hard to remember to take their medication regularly. If so, you may be offered 'observed treatment', where a health worker sees you for each dose. The treatment schedule is adjusted so that medication is taken three times weekly instead of daily.

Drug-resistant TB

Some people have TB bacteria which are 'resistant' to certain antibiotics - meaning that the bacteria are not killed by that antibiotic. This means that other antibiotics have to be used instead, to cure the TB. So antibiotic resistance can make the TB more difficult to treat and more dangerous to others who are infected. Difficulty of treatment is increased if the bacteria are resistant to more than one antibiotic. This is called multidrug-resistant (MDR) TB. If the bacteria are resistant to more than three antibiotics, this is called extensively drug-resistant TB.

Drug-resistant TB can be due to not taking a full course of treatment, or to catching TB with bacteria that are already resistant.

If you have (or may have) drug-resistant TB then extra precautions are needed to prevent the infection spreading to others. Your health worker will advise about this. You will need different antibiotics from the standard treatment above, with advice from a specialist.

TB and HIV infection

TB is more common in people with HIV infection. It may be more difficult to diagnose, because the symptoms and test results may not be typical. Also, treatment can be more complex because the TB medication and the HIV medication can interfere with each other. Specialist advice may be needed.

Sometimes, if you have TB and then start antiviral treatment for HIV, the TB symptoms can get worse for a while. This happens because the immune system gets stronger and produces a reaction to the TB infection.

Steroid treatment

Steroid treatment (prednisolone) is recommended as an additional treatment for some forms of TB. If there is TB in the brain (meningitis), or TB around the heart (pericarditis), then a course of prednisolone can help prevent complications.

Further reading and references

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