Tuberculosis treatment involves the use of oral antibiotics like rifampin, isoniazid, pyrazinamide, ethambutol, and rifapentine to eliminate the Mycobacterium tuberculosis bacteria that is causing the infection.

Tuberculosis (TB) treatment is typically done through your local health department, which receives funding for its TB programs through the U.S. Department of Health and Human Services’ Center for Disease Control and Prevention (CDC). Treatment will vary depending on the stage of the disease and is often managed by a pulmonologist or infectious disease specialist.

In addition to antibiotics, tuberculosis treatment may involve the use of other medications like vitamin B6 to prevent neurotoxicity, corticosteroids for treatment of meningeal tuberculosis, antipyretics to help lower fever, or other medications based on symptoms.

woman with eyes closed and hand on her chest

Medication regimens

Tuberculosis treatment involves a combination of different antibiotics that may vary depending on the stage of the disease. The most common treatment regimens include:

1. Rifampin, isoniazid, pyrazinamide, and ethambutol

The basic regimen using rifampin, isoniazid, pyrazinamide, and ethambutol is indicated for the initial intensive treatment of both pulmonary and extrapulmonary tuberculosis in adults and children over 10 years of age.

The initial phase of treatment lasts for 2 months. Doses of these medications are based on body weight and will be determined by your doctor.

This intensive phase of treatment will be followed by a continuation, or maintenance, phase.

2. Rifampin, isoniazid, and pyrazinamide

This basic regimen using a combination of rifampin, isoniazid, and pyrazinamide is indicated for the initial intensive treatment or re-treatment of pulmonary and extrapulmonary tuberculosis in children under 10 years of age.

Treatment with this regimen lasts for 2 months but may continue for more than 10 months in the case of meningeal tuberculosis or more than 12 months in the case of extrapulmonary tuberculosis.

Doses of rifampin, isoniazid, and pyrazinamide are based on body weight and will be determined by your doctor.

4. Rifampin and isoniazid

The combination of rifampin and isoniazid is indicated for maintenance treatment of pulmonary and extrapulmonary tuberculosis in adults and children over 10 years of age.

This maintenance phase lasts for 6 to 10 months and follows the initial intensive phase of treatment. Doses of these medications will be determined by your doctor.

Rifampin and isoniazid are also indicated for the initial intensive treatment or re-treatment of pulmonary and extrapulmonary tuberculosis in children less than 10 years of age.

5. Isoniazid, rifampin, and rifapentine

Isoniazid, rifampin, or rifapentine are typically indicated for the treatment of latent tuberculosis, or the dormant phase of the disease.

It is very important to treat tuberculosis in the latent phase, as the disease can become active at any time and be more difficult to treat.

Doctors will generally prescribe only isoniazid or rifampin, or a combination of isoniazid + rifapentine, to be taken for 3 to 9 months or until the bacteria are completely eliminated as confirmed by testing.

In the case of antibiotic resistance, your doctor may prescribe other types of antibiotics depending on sensitivities.

6. Vitamin D supplements

Vitamin D is important in regulating the immune system, helping the body's defense cells eliminate inflammatory proteins and increase production of proteins that help eradicate bacteria such as those that cause tuberculosis.

Vitamin D can also help reduce the severity of an active TB infection as well as the reactivation of latent TB.

Vitamin D may therefore be prescribed by a doctor in the case of a vitamin D deficiency, however it does not take the place of treatment with antibiotics, as vitamin D cannot eliminate bacteria from the body.

7. Vitamin B6 supplements

Vitamin B6 supplements contribute to healthy functioning of the nervous system and may be prescribed to prevent peripheral neurotoxicity caused by the use of ethambutol and isoniazid.

Children undergoing tuberculosis treatment who are malnourished or have HIV may also be prescribed vitamin B6 supplements (pyridoxine).

Vitamin B6 is not a substitute for antibiotics but it may help prevent side effects. It should be taken only if prescribed by a doctor.

Treatment in pregnancy

Tuberculosis treatment during pregnancy consists of the same medications used for the initial and maintenance treatment of tuberculosis in nonpregnant adults: rifampin, isoniazid, pyrazinamide, and ethambutol. Rifapentine is contraindicated in pregnancy.

Due to the risk of fetal neurotoxicity, a doctor may prescribe vitamin B6 supplements at a dose of 50 mg per day.

Tuberculosis treatment during pregnancy is very important for both the pregnant person and the fetus in order to decrease the risk of transmitting tuberculosis to the fetus or newborn as well as preventing spread of the disease to others.

Treatment during lactation

Tuberculosis treatment during lactation is done with the same antibiotics used during initial and maintenance treatment of tuberculosis in the general adult population. Small quantities of these medications may pass through the breast milk, however breastfeeding is not contraindicated during tuberculosis treatment.

However, it is recommended for the infected individual to mask while breast or bottle feeding the baby as long as the sputum test is positive for bacillus.

Care instructions

People undergoing tuberculosis treatment should be sure to:

Take all medications at the correct times and not stop treatment without being advised to do so by a doctor;
Keep all follow up appointments with your doctor and healthcare team (usually at least once a month);
Complete all tests as ordered by your doctor, including hepatic and renal function tests and fasting glucose;
Perform a sputum smear microscopy exam once a month as well as a thoracic x-ray when ordered by your doctor;
Take medications after meals to prevent stomach pain and discomfort, or as advised by your doctor;
Isolate during the first 15 days of treatment.

In addition, be sure to cover your mouth with a tissue when you cough or sneeze, wear a surgical mask around others, and avoid public areas and enclosed spaces, especially during the first 2 to 3 weeks of treatment.

People who have the potential to become pregnant should be sure to use a barrier method of contraception while undergoing treatment for tuberculosis, as TB treatments like rifampin can decrease the effectiveness of birth control pills.

Side effects

The main side effects of tuberculosis treatment are:

Nausea, vomiting, and frequent diarrhea;
Loss of appetite;
Yellowing or redness of the skin, itchiness, and rash;
Inflammation of the optic nerve or uveitis;
Liver toxicity.

Tuberculosis treatment may also cause an increase in uric acid, especially in people with gout, acute gouty arthritis, joint pain, or peripheral neuropathy.

It is important to contact your doctor or healthcare team if you experience any side effects from tuberculosis treatment. Your doctor may need to prescribe a different medication or change the dose.

Response to treatment

Signs of improvement are usually noted about 2 weeks after starting treatment and include lessening of fatigue, resolution of fever, and relief of muscle aches.

Signs of worsening infection are more frequent when treatment is not started right away, especially in cases of latent tuberculosis in which the person does not realize they are infected. These signs include a fever higher than 38°C (100.4°F), general malaise, night sweats, and muscle aches.

Other symptoms like coughing up blood, localized swelling, and weight loss may also occur, depending on the location of the infection.