Getting Treatment for Tuberculosis
Once you’ve been diagnosed with TB, treatment involves taking medications as directed by your healthcare team. You’ll also have regular visits to make sure the medication is working and your body is tolerating it. A TB infection can be latent or active. Latent means the bacteria are dormant in the body; you have no symptoms, and you’re not contagious. In the active form of the disease, which is infectious, the bacteria multiply in the body, causing symptoms. But both forms should be treated. (1) A standard treatment regime for latent TB is taking the antibacterial drug isoniazid for six to nine months. Treatment of active TB usually involves a combination of three or four drugs. The most commonly used are these options: (1,2)
IsoniazidRifampin (Rifadin)PyrazinamideEthambutol (Myambutol)
Before and during treatment, your doctor may run these tests: (3)
A blood test to check your liver function, since TB drugs can be hard on the liverA sputum (phlegm) test to see if the antibiotics are working against the bacteriaA chest X-ray to look for TB in the lungs
How to Avoid Spreading Tuberculosis
If you have active TB, it will take about two to three weeks of being on medicine before you’re no longer contagious. In the meantime, you’ll want to avoid spreading the disease to others. TB is spread through the air, so if you cough, sneeze, or laugh, you’re releasing bacteria. Anyone who inhales the same air is at risk of getting infected. (4) Close contact for a prolonged period of time is generally needed to spread TB, says Asim Jani, MD, a hospital epidemiologist at Orlando Health in Florida. That’s why you’re most likely to infect people you spend lots of time in close proximity to, like family members in the same household. If you’re recovering from active TB at home, here are some things you can do to prevent spreading the disease: (4,5,6)
Don’t go to work or school until your doctors give the okay.Keep yourself separated from family in the home by staying in your own room.Wear a face mask that covers your nose and mouth.Carefully seal any used tissues that you’ve coughed or sneezed in inside a bag and throw them away.Open a window in the room to let air with bacteria get carried outside. Placing a fan in the window can help draw out air, providing better ventilation. TB is more likely to spread in small closed spaces where the air doesn’t move.Tell any friends or family you’ve had close contact with to get tested for TB.
Maintaining a TB Medication Routine
Even after you start feeling better, the bacteria are still in your system. Tuberculosis bacteria grow and progress slowly, but they also die slowly. That’s why it’s extremely important to take all of your medication as directed by your medical team. If you stop too early, the bacteria can start growing again and become resistant to the drugs, making it much harder to treat. (6) People often don’t understand the seriousness of TB, according to Hayan Yacoub, MD, an internal medicine practitioner at Austin Regional Clinic in Texas. He stresses that it’s important to commit to the full course of treatment. You’ll be taking medication on a schedule for several months, and it can be easy to forget. Here are some tips to keep yourself on track:
Set calendar reminders and alarms on your phone that tell you when it’s time to take medicine.Make taking your medicine part of your regular daily routine by taking the pills first thing in the morning or at mealtime if they need to be taken with food.Use a weekly pill box to keep organized.Have a family member or friend help remind you.Tell your doctor if you miss a dose and ask what to do.
If you have active TB, your doctor may recommend direct observation therapy (DOT) to help you stick to a proper treatment regimen. In DOT, a trained healthcare worker provides each dose of medication, watches the person swallow it, and documents that the medication has been taken. (4,6) The professional may meet you at home or at a medical facility or TB clinic. You’ll have regularly scheduled meetings until treatment is complete.
Potential Side Effects of TB Medications
While most people are able to tolerate TB medication well during treatment, side effects are possible, and some can be very serious. These medications can be toxic to the liver, so people being treated for TB need to be monitored carefully, says Alexea Gaffney-Adams, MD, an internist and pediatrician with subspecialty training in infectious disease at Stony Brook Medicine in Smithtown, New York. If you experience any of the following symptoms, tell your doctor or care team right away: (4,6,7)
Loss of appetiteNausea or vomitingYellowing of skin or eyes (a sign of liver damage)Fever that lasts longer than three daysFatigueDark-colored urinePain in the abdominal areaTingling in the fingers or toesFeeling itchy with no known causeRash on the skinDizzinessMuscle weakness or aching jointsChanges in visionChanges in hearing, like hearing loss or ringing in the ears
Which Medications Should Be Avoided During Treatment?
When you meet with your doctor for TB treatment, it’s important to let them know about any other medications you’re taking, including over-the-counter drugs. You may need to stop certain medications while on TB treatment because of drug interactions or potential strain on the liver. “One of the common adjustments I’ve had to make is stopping people’s cholesterol meds [during TB treatment] because both are associated with liver toxicity,” says Dr. Gaffney-Adams. She also recommends choosing nonsteroidal anti-inflammatory drugs for pain relief because they are processed through the kidneys, not the liver, like acetaminophen (Tylenol). Isoniazid, one of the first-line drugs used for both latent and active TB, can cause serious side effects in the liver when combined with acetaminophen. (8)
Lifestyle Changes to Reduce Liver Damage and Improve Nutrition
In the days before antibiotics, when people with TB were sent to sanatoriums, the reasoning was that rest, fresh air, and good nutrition made the immune system strong enough to fight off TB bacteria. Although antibiotics are needed to cure TB, improving your diet to include more healthy foods is also an important part of restoring, and maintaining, good health. Nutrition and tuberculosis are still closely linked in developing countries. Malnutrition can make someone more likely to develop TB, and having active TB can also cause weight loss and malnutrition. When the body isn’t taking in enough nutrients, the immune system can be left vulnerable. (9,10) General improvements in health have shown drastic reductions in TB cases, says Dr. Yacoub. He recommends eating healthily and exercising regularly to keep your immune system strong. Changes you can make at home include these behaviors:
Eating more fruits and vegetablesEating healthy fats and proteinsDrinking plenty of waterAvoiding saturated fats, which can be damaging to the liverAvoiding alcohol — even small amounts can be dangerous to someone already on TB medications because the liver will have to work harderGetting regular mild to moderate exercise once symptoms of active TB have gone away
“I encourage a lot of water intake. We need to be hydrated to be in an ideal state to process these medications,” says Gaffney-Adams. She also encourages her patients to work toward overall health and wellness improvements, which, she says, can help the body better tolerate medications.
