We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
However, TB treatment is not quick or easy. The length of treatment and side effects from the drugs used pose huge problems for TB patients and for global efforts to tackle the disease. Find out more under Global TB challenges.
TB treatment lasts at least six months. Treatment for TB is usually a mixture of four antibiotics:
Isoniazid, Rifampicin and Pyrazinamide can come in the same tablet, called Rifater.
After two months of being on this regimen, patients may then be moved on to a course of two antibiotics for four months: Rifampicin and Isoniazid. These can come in the same tablet, called Rifinah.
Patients may begin to feel better within two weeks of beginning treatment. People with pulmonary TB normally become non-infectious in the same period. However, it is important for patients to complete their treatment, so that the TB bacteria are completely killed off in the body. This prevents symptoms from returning and the risk of bacteria becoming drug resistant.
Treating drug-resistant TB
Drug-resistant TB requires a longer course of treatment, with different combinations of drugs. Drug-sensitivity testing is required to determine the course of treatment. However, treatment for drug resistant forms of the disease is likely to be less effective, with more side effects.
- First line drug resistance: a patient does not respond to one of the standard TB antibiotics
- Multi-drug resistant TB (MDR-TB): a patient does not respond when treated with Isoniazid and Rifampicin
- Extensively drug resistant TB (XDR-TB): MDR plus resistance to two other groups of antibiotics (fluoroquinolones and injectable second-line drugs)
See Global TB challenges: Drug-resistance
Treating latent TB
Most cases of latent TB are not considered for treatment, as 90% of people with latent TB do not go on to develop active TB. Treatment is recommended for people whose immune systems are weaker as they are more likely to go on to develop an active infection. This includes children and people living with HIV.
The dormant bacteria present in cases of latent TB can be cleared completely using some of the same drugs used to treat active TB.
Directly Observed Treatment (DOT)
TB treatment takes at least six months, patients need to take many tablets each day and side effects are common. This can be difficult to manage. However, it is crucial that TB patients take their treatment as prescribed and complete the course, to ensure they are cured completely and to prevent drug-resistance emerging.
Directly Observed Treatment, or DOT for short, is a way of supporting people to complete their treatment. Depending on the country, DOT may be delivered through regular visits to a clinic or pharmacy, house-to-house visits by TB nurses or outreach volunteers, or by trained volunteers from local settings, including shops.
DOT supports patients throughout their treatment, and ensures that medication is taken correctly:
- The correct drugs
- In the right doses
- At the correct intervals
- Completing the course
In the UK, DOT is recommended for people who have difficulty keeping to a course of treatment – perhaps through lifestyle factors such as homelessness – and for people affected by MDR-TB. Worldwide, DOT is a key element of WHO’s Directly Observed Treatment Shortcourse strategy.