You'll be prescribed at least a 6-month course of a combination of antibiotics if you're diagnosed with active pulmonary TB, where your lungs are affected and you have symptoms.
The usual treatment is:
- 2 antibiotics (isoniazid and rifampicin) for 6 months
- 2 additional antibiotics (pyrazinamide and ethambutol) for the first 2 months of the 6-month treatment period
It may be several weeks 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 antibiotics for 2 weeks, most people are no longer infectious and feel better.
However, it's important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics.
Taking medication for 6 months is the best way to ensure 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 because it can be difficult to treat and will require a longer course of treatment with different, and possibly more toxic, therapies.
If you find it difficult to take your medicine 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, at the treatment clinic, or somewhere else that's more convenient.
If treatment is completed correctly, you should not need any further checks by a TB specialist afterwards. You may be given advice about spotting signs that the illness has returned, although this is rare.
Extrapulmonary TB – TB that occurs outside the lungs – can be treated using the same combination of antibiotics as those used to treat pulmonary TB.
If you have TB in areas like your brain or the sac surrounding your heart (pericardium), you may initially 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.
Though uncommon in the UK there are strains of TB that are resistant to 2 or more antibiotics. This is known as multidrug-resistant TB.
Multidrug-resistant TB requires a much longer course of antibiotics; between 9 to 24 months depending on the strain. Multidrug-resistant TB tends to have less favourable outcomes than standard TB.
Latent TB is where you've been infected with the TB bacteria, but do not have any symptoms of active infection.
If you have latent TB and are aged 65 or under, treatment is usually recommended. However, the antibiotics used to treat TB can cause liver damage in older adults.
If liver damage is a concern and you're aged between 35 and 65, your TB team will discuss with you the advantages and disadvantages of taking treatment for latent TB.
Latent TB is also not always treated if it's thought 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 steroid medicines, chemotherapy or biological inhibitors like TNF inhibitors. This is because there's a risk of the infection becoming active.
Treatment for latent TB generally involves:
- either taking a combination of rifampicin and isoniazid for 3 months
- or isoniazid on its own for 6 months
Side effects of treatment
Isoniazid can cause nerve damage (peripheral neuropathy). You'll be given supplements of vitamin B6 (pyridoxine) to take alongside it to reduce this risk. Your liver function will be tested before you start treatment.
In rare cases, the antibiotics used to treat TB can cause eye damage, which can be serious. If you're going to be treated with ethambutol, your sight 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 the whites of your eyes (jaundice)
- an unexplained high temperature
- tingling or numbness in your hands or feet
- a rash or itchy skin
- changes to your sight, such as blurred vision
Rifampicin can reduce the effectiveness of some types of contraception, such as the combined contraceptive pill. You should use an alternative method of contraception, such as condoms, while taking rifampicin.
Rifampicin can also interact with other medication, so it's important that your TB team know about all of the medicine you're taking before you start treatment for TB.
Preventing the spread of infection
If you're diagnosed with pulmonary TB, you'll be contagious up to about 2 to 3 weeks into your course of treatment.
You will not usually 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.
- stay away from work, school or college until your TB treatment team advises you it's 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
- not sleep in the same room as other people – you could cough or sneeze in your sleep without realising it
What if someone I know has TB?
When someone is diagnosed with TB, their treatment team will assess whether other people are at risk of infection.
This may include close contacts, such as people living with the person who has TB, as well as casual contacts, such as work colleagues and social contacts.
Anyone who's thought to be at risk will be asked to go for testing, and will be given advice and any necessary treatment after their results.
See diagnosing TB for more information.