Treatment

People with a positive tuberculin skin test may or may not receive preventive medication therapy. This will depend on the exposure history, the timing of the skin test conversion (when the test changes from negative to positive) and other factors in the person's medical history. When it is known that a person has recently been in close contact with someone with active tuberculosis and has developed a positive tuberculin skin test, preventive treatment is advisable. This is due to a high risk of developing active disease. INH (Isoniazid) may be prescribed for nine months as preventive treatment.

Since the advent of anti-tuberculosis (anti-TB) medications in the 1940s, the treatment of drug-susceptible TB has become highly effective if administered and taken properly. Treatment no longer requires prolonged hospital stays. In many cases, a person with a new case of TB can be treated at home. Others will enter the hospital to be placed on a medication program and to be isolated until the disease is controlled. When the person is no longer infectious, he or she can leave the hospital and continue on medication at home. Hospitalization, in such cases, may be a few weeks to several months depending on the severity of the disease and the effectiveness of the treatment program.

In most cases, a treatment program for drug-susceptible TB involves taking two or four medications for a period of time ranging from six to nine months. Medications may include:

• Isoniazid
• Rifampin 
• Pyrazinamide 
• Ethambutol 
• Streptomycin

Multiple medications are often needed. It is important to take all of the doses prescribed. Often all of the TB germs cannot be destroyed with one medication.
It is important to realize that hospitalization for a person with TB, when necessary, represents only the beginning of treatment. Since active TB is slow to respond completely to therapy, prescribed medications must be taken every day for a long period of time. This may be at least 6 months, and in some cases for a year or more. If the TB medications are not taken regularly, serious complications may develop:

• The organisms may become resistant to one or more of the drugs.

• There may be an increased risk of toxic reactions from the medications.

• There is a high risk of disease relapse or recurrence.

Given the many effective medications available today, the chances are great that a person with TB can be cured. It is important, however, for the person to understand the disease and to cooperate fully in the therapy program.

Drug-resistant TB

In a small percentage of cases, the initial treatment does not go as planned. The medication program may not be sufficient for a certain infection. The medications may not be absorbed properly. It may be that the person is not taking the medications regularly. In these people, there is a tendency for the germs to become resistant to some or all of the medications. Sometimes a person has initial drug-resistant disease. In other words, the TB germs they contracted were from a person with drug-resistant TB.
Drug-resistant TB is very difficult to treat. It often requires more and different medications for a longer period of treatment. Sometimes, surgery is needed to remove areas of destroyed lung that contain germs that are inaccessible to antibiotics. A person with drug-resistant TB should be treated by a specialist with considerable experience in managing the disease. This treatment should be initiated in a hospital setting.

This information has been approved by Gwen Huitt M.D. (April 2006).