infections
Tuberculosis (TB)
Treatment of Tuberculosis
Isolation Antibiotics Sometimes surgery or corticosteroids Most infected people do not need to be hospitalized for treatment. People are hospitalized if they Are seriously ill with tuberculosis Have another serious disorder Need to have diagnostic procedures Do not have an appropriate place to go to (for example, if they are homeless) Need to be isolated, such as people who live in a group situation where they would regularly encounter previously unexposed people (such as a nursing home) People with pulmonary tuberculosis being treated in a hospital are kept in isolation in a room that is specially designed to minimize the risk of spreading infections through the air. The door is kept closed as much as possible, and the air in the room is changed 6 to 12 times every hour. People who are kept in isolation do not need to wear a surgical face mask if they can cooperate with instructions on how to cover their coughs. However, people who enter the room must wear a respirator (a specially fitted filter device, not a simple surgical mask). People can move from isolation into a general hospital room when they have clearly responded to treatment—typically, when all of the following occur: Their sputum samples have been negative (no tuberculosis bacteria seen) for a period of time. They no longer have a fever. They have regained their appetite and sense of well-being. A number of antibiotics are effective against tuberculosis. But because tuberculosis bacteria are very slow-growing, antibiotics must be taken for a long time—for 4 to 6 months or longer. Treatment must be continued long after people feel completely well. Otherwise, tuberculosis tends to recur because it was not fully eliminated. Also, the tuberculosis bacteria may become resistant to the antibiotics. Most people find it difficult to remember to take their drugs every day for such a long time. Other people, for various reasons, stop treatment as soon as they feel better. Because of these problems, many experts recommend that people with tuberculosis receive their drugs from a health care worker, who watches them take the pills. This approach is called directly observed therapy (DOT). Because DOT ensures that people take every dose, the drugs are often given just 2 or 3 times per week after the first 2 weeks. Two or more antibiotics that work in different ways are always given because treatment with only one drug can leave behind a few bacteria resistant to that drug. With most other bacteria, a few bacteria would not be enough to cause a relapse, but if tuberculosis is treated with only one drug, the tuberculosis bacteria soon become resistant to that drug. Until recently, there weretwo phases of treatmentfor people who have not been treated before: Intensive phase: People take four antibiotics for 2 months. Continuation phase: People take only two antibiotics for 4 to 7 more months, depending on the results of sputum tests and chest x-rays. Today, certain people may be eligible for a treatment regimen that lasts for 4 months and includes only two drugs. Themost commonly usedantibiotics are Isoniazid Rifampin Pyrazinamide Ethambutol These four drugs may be used together and are used first (called first-line drugs). All of these drugs have side effects, but most people with tuberculosis are cured with these drugs and do not have any serious side effects. There are many different combinations and dose schedules for these drugs.Isoniazid,rifampin, andpyrazinamidemay be contained in the same capsule, reducing the number of pills people have to take each day and reducing the chance of developing drug resistance. Unlike other antibiotics, those used to treat tuberculosis are usually taken all together at the same time, once a day or 2 or 3 times a week. are usually used when the bacteria causing tuberculosis have become resistant to first-line drugs or when people cannot tolerate the first-line drugs. Other antibiotics are used as second-line drugs. They include Aminoglycosides (such as Other, newer drugs have been developed to help treat tuberculosis that has become resistant to the usual drugs. These drugs includebedaquiline, delamanid, andpretomanid. Treatment of tuberculosis must be continued long after people feel well. Tuberculosis bacteria can easily develop resistance to antibiotics, particularly when people do not take the drugs regularly or for as long as they are supposed to. Bacteria that resist treatment with antibiotics are causing more and more cases of tuberculosis (called drug-resistant tuberculosis). Drug resistance is a serious concern because drug-resistant tuberculosis must be treated for a very long time. People typically must take four or five drugs for 18 to 24 months. Drugs used to treat drug-resistant tuberculosis are often less effective, more toxic, and more expensive. Tuberculosis bacteria that are resistant to antibiotics are classified based on the drugs they are resistant to. The World Health Organization (WHO) classifications are Multidrug-resistant tuberculosis (MDR-TB):Resistant to at leastisoniazidandrifampin Pre-extensively-drug-resistant tuberculosis (pre-XDR-TB):Resistance toisoniazidandrifampinand also any fluoroquinolone Extensively drug-resistant tuberculosis (XDR-TB):Resistant toisoniazid,rifampin, any fluoroquinolone, and at least one of the following drugs:levofloxacin,moxifloxacin,bedaquiline, orlinezolid The new tuberculosis drugsbedaquiline, delamanid, andpretomanidand the fluoroquinolonemoxifloxacinare active against resistant strains of tuberculosis bacteria and may help control the epidemic of drug resistance. Surgery to remove a portion of the lung is seldom needed if people faithfully follow the drug treatment plan. However, surgery is sometimes needed to treat people with the following: Very drug-resistant infections A cough that continuously brings up blood Blocked airways Pus that has accumulated (to drain it) When tuberculous pericarditis causes significant restriction of the heart’s motion, the pericardium may need to be removed surgically. A tuberculoma (a mass that develops because of tuberculosis) in the brain may need to be surgically removed. Doctors sometimes give corticosteroids (such asdexamethasone) when tuberculosis causes a significant amount of inflammation, particularly in people with meningitis, pericarditis, or lung inflammation. 