TB - Treating tuberculosis

Treatment for tuberculosis (TB) will usually involve a long course of antibiotics lasting several months.

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

For most people, a 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 given 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

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 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 the TB bacteria are killed. If you stop taking your antibiotics before you complete the course, or 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 you find it difficult to take your medication every day, your treatment team can work with you to find a solution. This may include having regular contact with your treatment team at home, the treatment clinic, or somewhere else more convenient.

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 in areas such as 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's important to take your medicines exactly as prescribed and to finish the whole course.

Latent TB

Latent TB is when 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 aged 35 years 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 never received treatment 

Treatment is not recommended for people who have latent tuberculosis and are over the age of 35, do not have HIV and are not healthcare workers. This is because the risk of liver damage caused by antibiotic treatment increases with age, and the risks of treatment may outweigh the benefits.

Latent TB is also not always treated if it's 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, testing and treatment for latent TB may be recommended for people who require treatment that will weaken their immune system, such as long-term corticosteroids, chemotherapy or TNF inhibitors. This is because there is a risk of the infection becoming active.

Treatment for latent TB generally 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 the antibiotics used to treat TB can cause damage to the liver or eyes, which can be serious. Your liver function therefore 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 if you develop any worrying symptoms during treatment, such as:

• being sick 
• yellowing of your skin and whites of your eyes (jaundice)
• an unexplained high temperature (fever)
• tingling or numbness in your hands or feet
• a rash or itchy skin
• changes to your vision, such as blurred vision

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

Preventing the spread of infection

If you are diagnosed with pulmonary TB, 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's important to take some basic precautions to stop TB spreading to your family and friends. You should:

• stay away from work, school or college until your TB treatment team advises you it is safe to return 
• always cover your mouth – preferably with a disposable tissue – 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 in the areas where you spend time
• do not sleep in the same room as other people as you could cough or sneeze in your sleep without realising it