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Tuberculosis has been around for thousands of years. In 2018, almost one-quarter of the human race was infected with tuberculosis. It has been 140 years since the tuberculosis bacterium was discovered, and medical science has created several antibiotics to help control this deadly illness.
What is tuberculosis?
Tuberculosis (TB) is a potentially fatal bacterial infection that usually infects the lungs but can infect any organ in the body. The mortality rate for untreated active TB infections is high, but a six-month regimen of antibiotics clears the infection in nearly all patients.
The organism responsible for tuberculosis, Mycobacterium tuberculosis, travels from person to person in tiny, aerosol water droplets that are sneezed or coughed out by a person with an active tuberculosis lung infection.
Mycobacteria are particularly hard to kill. Their extra thick and complex cell walls allow them to survive alcohol, corrosive acid, caustic bases, dehydration, many antibiotics, and cells in the immune system designed to kill bacteria.
Over half of those exposed to tuberculosis do not get infected. For those who do get infected, most develop a symptomless and non-contagious infection called latent tuberculosis infection (latent TB or LTBI). It is a harmless infection, but it can flare up into an active TB infection if the immune system is weakened. Most people with latent tuberculosis, however, live out their entire lives without any symptoms or injuries from the infection.
About 5% to 10% of people infected with tuberculosis will develop a potentially life-threatening infection of the lungs called active tuberculosis. In fighting off the infection, the immune response damages and kills lung tissue. However, not all active tuberculosis infections are lung diseases. In some patients (about 14%) the infection develops elsewhere, such as the gastrointestinal tract, brain, spine, muscles, bones, liver, kidney, reproductive system, lymph nodes, or skin.
Both active and latent tuberculosis infections can flare up again as active infections, called reactivation infections. Over time, the damage done to the lungs and other organs proves to be lethal. The mortality rate for untreated, recurring active tuberculosis is 50%.
Tuberculosis is one of the most common infectious diseases in the world. One out of four people worldwide—that’s about 2 billion total—are infected with latent tuberculosis. In the United States, however, public health measures have made tuberculosis relatively rare. According to the Centers for Disease Control and Prevention (CDC), close to 9,000 people in America were diagnosed with active tuberculosis in 2019 and about 13 million people are infected with latent tuberculosis.
How is tuberculosis diagnosed?
Diagnosis is based on tuberculosis screens, symptoms, chest imaging, and identifying the mycobacteria through a microscope, culture, or by identifying mycobacteria genes. Active infections, however, are highly contagious, so rapid isolation and treatment are critical.
Active infections usually only develop only when there is a problem with the immune system or damage to the lungs, so the risk factors for an active tuberculosis infection are
- AIDS/HIV,
- Immunosuppressive drugs
- Chronic lung disease
- Smoking
- Diabetes
- Poverty and malnutrition
- Travel from an area with a high incidence of tuberculosis.
Patients are screened for tuberculosis using the tuberculin skin test (TST) or a blood test that identifies specific antibodies to the tuberculosis mycobacterium (INF-ɤ Reactivity Assay or IGRA). These tests do not show a TB infection, they only show that the patient has been exposed to TB or received a TB vaccine.
A diagnosis of active tuberculosis is based on:
- Symptoms: chronic cough, low fever, night sweats, fatigue, and weight loss
- A chest X-ray that shows tuberculosis lesions (tubercles)
- The presence of acid-surviving bacteria in sputum or bronchoscopy specimen as seen through a microscope
- Evidence of the tuberculosis bacteria in a culture or gene test. If the active TB infection is not in the lungs, a biopsy will be performed on the affected organ.
Most active TB infections, however, are in the lungs, so the definitive standard for diagnosing pulmonary TB is a chest X-ray and a culture of the live bacteria from sputum.
For patients without symptoms, latent TB infection is typically first identified with a positive tuberculin skin test or IGRA. A positive tuberculosis screen will be followed up by a chest X-ray, physical exam, and sputum examination.
Drug-resistant strains of mycobacteria are a growing problem. Some strains (multidrug-resistant TB or MDR-TB) are not affected by the two major antibiotics used to treat tuberculosis, and some have resistance to four or more antibiotics (extensively drug-resistant TB or XDR-TB). For that reason, healthcare providers will test live cultures for their drug susceptibility to determine what medications to use.
Tuberculosis treatment options
Active tuberculosis is often treated on an outpatient basis, but hospitalization may be required for some cases. Latent tuberculosis is always treated on an outpatient basis. Treatment will be coordinated with TB control agencies and public health officials to ensure medication and treatment compliance.
Medications
Treatment for active or latent tuberculosis consists almost entirely of antibiotics. The treatment regimen is lengthy and will involve several different types of antibiotics to clear the infection.
Isolation
An active pulmonary TB infection is highly contagious, so patients will be asked to partially isolate themselves from family and other people they live with, wear a respirator mask at all times outside the house, and may even be hospitalized to prevent spreading the contagion.
Hospitalization
Patients with active TB who are very sick or are not taking medications may be hospitalized and isolated in a single, negative pressure room that does not allow microbes to escape.
Follow-up care
Both latent and active TB take a long time to treat and the medications have unpleasant and sometimes serious side effects. Patients treated for TB always require extensive follow-up to ensure the drugs are being taken, side effects are being managed, and the infection is clearing.
Direct observation therapy (DOT)
Because many patients stop taking their drugs, a public health official, nurse, or another healthcare provider will be assigned to bring drugs to the house and watch the patient take each day’s drug dose. This is called direct observation therapy, and it is considered the most effective way to treat tuberculosis. World Health organization has been implementing this program across the globe to fight TB.
Tuberculosis medications
TB treatment consists of a long treatment regimen of antibiotics. Typically lasting for six months, antibiotic treatment could take as long as 12 months. There are strict guidelines on antibiotics selection and duration. Side effects are common, often a source of discomfort, and can be severe. Because of drug resistance, healthcare providers follow a well-designed architecture of first-line, second-line, and third-line anti-tuberculosis drugs.
First-line antibiotics
The first-line treatment for active TB is a six-month antibiotic regimen consisting of a two-month intensive phase followed by a four-month continuation phase. In the intensive phase, patients will take four drugs that specifically target mycobacteria: isoniazid (INH), rifampin, ethambutol, pyrazinamide, and sometimes rifapentine. Only isoniazid and rifampin are used in the four-month continuation phase. Treatment may last as long as nine months.
The first-line antibiotic treatment for latent TB is a nine-month course of isoniazid or a shorter course of treatment combining isoniazid with other drugs, such as rifapentine or rifampin.
Other antibiotics
Multidrug-resistant tuberculosis is defined as any strain that is resistant to both isoniazid and rifampin, making first-line antibiotic therapy useless. Other combinations of antibiotics are required for MDR-TB and XDR-TB, including second-line antibiotics (amikacin, kanamycin, streptomycin, capreomycin, viomycin, fluoroquinolones), and less-effective third-line antibiotics, such as linezolid, clarithromycin, and amoxicillin. It is extremely important to complete the full course of antibiotics as prescribed even though the symptoms improve within weeks. If antibiotics are stopped prematurely, a simple TB infection develops into an MDR-TB or XDR-TB infection.
Vaccines
Injectable Bacille Calmette-Guérin, or BCG, is a vaccine used throughout the world to boost immunity to tuberculosis. It is rarely used in the United States because it results in a positive tuberculosis skin test, making screening for TB difficult. However, it is used in America for healthcare providers and children who live with patients who have active tuberculosis.
Other medications
Isoniazid, which is also called INH, is the most widely used and effective drug against mycobacterium tuberculosis. However, it has several side effects. Most severely, isoniazid interferes with the body’s ability to make and use vitamin B12, or pyridoxine, which leads to nerve damage, called INH-induced neuropathy. Patients on isoniazid therapy will also be prescribed a pyridoxine supplement to prevent neuropathy.
What is the best medication for tuberculosis?
Healthcare providers follow a set of guidelines for antibiotic tuberculosis treatment. The first-line TB drugs are isoniazid, rifampin, ethambutol, and pyrazinamide, but other antibiotics may be used based on the bacteria’s drug resistance and the patient’s tolerance to the drugs. While these four drugs are the preferred TB drugs, the “best” drug will be determined by the mycobacteria’s drug resistance, and the severity of side effects.
| Best medications for tuberculosis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Isoniazid | Antimycobacterial antibiotic | Oral | Dose depends on patient weight | Liver damage, nerve damage, hypersensitivity |
| Rifadin (rifampin) | Antimycobacterial antibiotic | Oral | Dose depends on weight | Nausea, flu symptoms, liver damage |
| Myambutol (ethambutol) | Antimycobacterial antibiotic | Oral | Dose depends on weight | Optic nerve damage, hypersensitivity, nausea |
| Pyrazinamide | Antimycobacterial antibiotic | Oral | Dose depends on weight | Joint pain, nausea, liver toxicity |
| Priftin (rifapentine) | Antimycobacterial antibiotic | Oral | Four 150 mg tablets twice a week for two months then once a week for four months | Nausea, flu symptoms, liver damage |
| BCG Vaccine (Bacille Calmette-Guerin) | Vaccine | Intradermal injection | One vial injected below the skin | Swollen lymph nodes, site reactions, BCG infection |
| Pyridoxine | Vitamin | Oral | 10-25 mg daily | Decrease in vitamin B9, decreased sensation, headache |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of tuberculosis medication?
Different classes of antibiotics have different side effects, but first-line TB drugs can have serious side effects compared to other antibiotics. This is not a complete list of side effects, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.
First-line TB drugs
All the first-line TB drugs have relatively common serious side effects that often result in patients giving up on the drugs. The most serious are liver problems and liver toxicity, so any course of treatment will involve regular blood tests to assess liver function. Isoniazid can also cause nerve damage and severe allergic reactions. Rifampin has a high incidence of hypersensitivity reactions. It also causes body excretions such as urine, sputum to turn reddish-brown/orange colored. Pyrazinamide causes pain in several joints. Ethambutol can cause painful swelling of the optic nerve that affects vision and could cause permanent blindness. A physician should be notified immediately if there is any vision change so ethambutol can be substituted with another antibiotic.
Other antibiotics
Second- and third-line antibiotics are more widely used for other bacterial infections and have fewer and less common side effects. These include upset stomach, diarrhea, constipation, and injection site reactions for injected antibiotics. Allergic reactions, including potentially life-threatening allergic reactions, are the most serious side effect of antibiotics.
What is the best home remedy for tuberculosis?
Tuberculosis cannot be treated or cured with home remedies or alternative medicines. The only effective remedy for tuberculosis is to take medications as prescribed and attend all scheduled appointments with healthcare providers. The most critical aspect of home health care, however, is to not spread the infection.
- Avoid too much contact with other members of the household
- Don’t spend much time in rooms that are used by other people
- Cover mouth when you cough or sneeze
- Wash hands regularly and always after coughing or sneezing
- Wear a special face mask given to you by doctor or hospital when in public
- Avoid crowded places and public transportation
To help fight the infection, remember that active tuberculosis thrives on a weakened immune system and compromised lungs. Also, TB drugs damage the liver, so avoid substances that compromise the liver, such as alcohol. Here are more things you can do:
- Eat a nutrition-rich diet
- Stop smoking
- Use an air purifier
- Scheduling daily activities
- Talking to friends and relatives daily on a cell phone or video conferencing
- Maintaining good sleep hygiene
- Talking regularly with a psychologist or counselor.
Frequently asked questions about tuberculosis
Can TB be completely cured?
In nearly all cases, tuberculosis can be completely cured with antibiotics.
Can TB cure itself?
If someone has an active or latent tuberculosis infection, the complete elimination of the mycobacteria is possible but exceedingly rare. The only way to eradicate the infection is through a lengthy antibiotic regimen.
What is the first-line drug for TB?
The most effective first-line drugs for tuberculosis are a combination of isoniazid and rifampin. For an active TB infection, these two drugs are combined with ethambutol and pyrazinamide for two months. Although rifampin is a first-line drug for TB, drug-resistant bacteria may need to be treated with rifapentine or rifabutin.
What is the best treatment for tuberculosis?
Tuberculosis can only be treated effectively with antibiotics. For most active infections, the most effective treatment will be a six-month course of multiple antibiotics consisting of isoniazid, rifampin, ethambutol, and pyrazinamide.
What are the side effects of TB medicine?
The first-line therapies for TB have frequent serious side effects including liver damage, nerve damage, retinal nerve swelling, and joint pain.
What are the side effects of rifampin?
Rifampin causes common minor side effects such as nausea, vomiting, itching, and flu symptoms. Rifampin is toxic to the liver and can cause serious allergic reactions, such as anaphylaxis, a hazardous, sudden drop in blood pressure.
What is the natural medicine for TB?
There are no effective natural or herbal remedies for active TB. The infection can only be cleared with antibiotics. Latent TB is a different matter. Latent tuberculosis always risks advancing to an active TB infection, but this usually only happens when the immune system is weakened. So while no natural medicine or dietary supplement can cure latent TB, many natural remedies and supplements can boost or strengthen the immune system. However, the best way to treat latent TB is to clear the infection with antibiotics.
How long does it take to recover from tuberculosis?
Tuberculosis is hard to kill. Antibiotic treatment typically takes 6 months to clear an active TB infection and up to twice that long if the person also has HIV/AIDS. Latent TB requires up to 9 months to be cleared with antibiotics.
How can I treat my TB at home?
TB can only be effectively eliminated from the body with antibiotics. The course of antibiotics is long, arduous, and both physically and emotionally draining. The best home treatment for TB is to take medications on schedule and keep all appointments with healthcare providers. Aside from that, take positive steps to avoid infecting others, eat nutritious foods, avoid smoking and alcohol, and set up daily activities to help maintain emotional health through the process.
Why is TB treated with multiple drugs?
Healthcare professionals worry that any TB infection will grow a drug-resistant strain of the bacteria, which is more likely if only one antibiotic is used. With multiple antibiotics, any drug-resistant bacteria will be killed off by at least one of the drugs in the antibiotic cocktail.
What foods are good for TB patients?
Many patients will be assigned a dietitian to help maintain a nutritious diet suitable for the treatment of the infection. Most TB patients suffer from significant weight loss. The diet should consist of nutrient-rich foods, low in fats, and not include substances that compromise the liver. Because TB drugs make people nauseous and can cause abdominal pain, avoid foods that upset the stomach and gut, such as spicy foods and sodas.
Related resources for tuberculosis
- Active Tuberculosis
- Basic TB Facts
- Current concepts in the management of tuberculosis
- Latent TB Infection Testing + Treatment: Summary of the U.S. Guidelines
- Medical Microbiology (4th edition): Chapter 33: Mycobacteria and Nocardia
- Pulmonary tuberculosis: diagnosis and treatment
- TB Tips: Advice for People with Tuberculosis
- Tuberculosis