Tuberculosis (TB) can be a fatal condition without proper treatment. Still, it’s curable. A doctor can help determine which course of antibiotics is best for you, but you must be sure to complete the course.

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mycobacterium tuberculosis. This condition primarily affects your lungs but can also attack your kidneys, spine, brain, and other organs.

The Centers for Disease Control and Prevention (CDC) estimates that up to 13 million people in the United States live with a latent (asymptomatic) TB.

Untreated TB can be fatal. But there’s an effective antibiotic treatment for this condition. Importantly, TB is curable with appropriate, timely, and complete courses of treatment.

Keep reading to learn about the treatment for TB, its types, effectiveness, side effects, and special considerations.

Latent TB doesn’t have symptoms and isn’t contagious. Still, latent TB can turn into an active (symptomatic) disease in around 10% of people. Therefore, it’s important to treat TB, even if it’s latent.

There are several treatment options for latent TB. The CDC recommends the following medications:

  • isoniazid
  • rifapentine
  • rifampin

Doctors can prescribe these medications on their own or in combination.

The 2020 CDC guidelines for doctors recommend a short course (3 or 4 months) of a rifapentine-based regimen over a longer course (6 or 9 months) of isoniazid for latent TB.

The treatment is oral, which means you take it by mouth. Depending on the formulation, you’ll need to take it daily, twice a week, or weekly.

Active TB causes symptoms and is contagious. Treatment can take from 4 or 6 to 9 months, depending on the regimen.

The CDC recommends the following treatment regimens:

Rifapentine-moxifloxacin TB treatment regimen

This 4-month daily regimen consists of:

RIPE TB treatment regimens

“RIPE” stands for:

  • rifampin
  • isoniazid
  • pyrazinamide
  • ethambutol

There are several RIPE regimens, ranging from 6 to 9 months of treatment.

All TB treatment regimens have an intensive phase and a continuation phase. The intensive phase typically includes more drugs. You must complete both phases to finish your treatment course.

Antibiotics successfully treat most TB infections. But conventional antibiotic regimens aren’t enough to cure some people. This is called drug-resistant TB. It happens when TB-causing bacteria become “immune” to one (mono-resistance) or more (multidrug resistance) types of antibiotics.

The CDC estimates that in 2020, resistance to isoniazid (one of the most common TB drugs) occurred in 456 newly diagnosed people in the United States. Multidrug resistance occurred in 56 people.

It’s still possible to treat drug-resistant TB, but picking an effective regimen can be very challenging. It involves a combination of multiple antibiotics that depend on many complex factors.

If you have drug-resistant TB, your doctor might suggest one of the following:

  • A different first-line antibiotic: This is the primary approach for mono-resistant TB.
  • Second-line treatment: This approach includes injecting antibiotics, such as amikacin, capreomycin, and kanamycin.
  • Fluoroquinolones: This group of antibiotics can cause severe, potentially disabling side effects. Doctors reserve them only for people who don’t have alternative treatment options.
  • Bedaquiline-linezolid-pretomanid combination regimen: This regimen has up to 93% efficacy in highly drug-resistant TB. But it carries serious risks and side effects. Doctors only use it after all other options (including fluoroquinolones) have failed.

It’s important to complete your treatment

Whether you have latent, active, or drug-resistant TB, it’s crucial to complete your treatment course.

After taking antibiotics for 2 weeks, you’ll likely feel better and may forget to take your medication. But if you don’t complete your treatment or skip a dose, your TB may come back. Worse yet, bacteria may become resistant to treatment, limiting your options for recovery.

There are many products and services to help you keep track of your medications. Ask a doctor what to do if you miss a dose.

Antibiotics that doctors use to treat TB can cause potentially serious side effects, including liver damage. Be sure to report any unusual effects of medications to your doctor, especially:

Note that it’s typical for rifampin and rifapentine to cause your urine to turn orange.

If your treatment involves isoniazid, you may experience peripheral neuropathy, especially if you’re an older adult. To prevent this, a doctor may ask you to take vitamin B6.

Although anyone can get TB, treating certain groups can be more challenging. Let’s discuss special considerations for the treatment of TB in some of these groups.

Pregnant people

If you’re pregnant, untreated TB presents a risk to you and your baby. You should begin treatment immediately if you have active TB.

If you’re pregnant and have latent TB, you can usually delay treatment until 2 to 3 months after delivery. But if you’ve had recent contact with someone with active TB or have other risk factors, you should begin treatment as soon as possible.

You should not take the following TB drugs during pregnancy:

  • streptomycin
  • kanamycin
  • amikacin
  • capreomycin
  • fluoroquinolones

Children

Babies and young children are at risk of developing life threatening forms of TB. It’s important to follow appropriate treatment protocols to prevent these complications.

The CDC recommends treatment of latent TB infections with once-weekly isoniazid-rifapentine for 12 weeks.

Doctors usually treat active TB infections in kids with the same antibiotics used in adults. But the CDC does not recommend the 4-month rifapentine-moxifloxacin regimen for children who are younger than 12 years old or weigh less than 88 pounds.

If children are in constant close contact with someone with TB, like a parent or guardian, they may benefit from the bacillus Calmette-Guérin (BCG) vaccine. Doctors don’t usually recommend the BCG vaccine in the United States, but it’s more common in regions where TB is more prevalent.

People with HIV

Although treating TB in people with HIV is similar to those without this condition, there are some key differences.

If you have HIV and TB (whether latent or active), the CDC recommends the following 6-month regimen:

  • Intensive phase: 2 months; isoniazid with rifamycin, pyrazinamide, and ethambutol
  • Continuation phase: 4 months; isoniazid with rifamycin

The CDC also recommends taking antiretroviral HIV therapy during the TB treatment, rather than delaying it until the end.

Although TB can be fatal, effective antibiotic treatment can cure this infection. Depending on the type of your infection and the recommended regimen, your treatment can take from 3 to 9 months.

Whether you have latent or active TB, complete the treatment regimen your doctor prescribes. TB drugs can cause some potentially serious side effects. Be sure to report any unusual symptoms to your doctor right away.

Although TB treatment is generally similar for everyone, pregnant people, children, and those with HIV may need certain modifications.