Treating Active Tuberculosis Disease

Treatment overview

TB germs become active if the immune system can't stop them from growing. When TB germs are active (multiplying in your body), this is called active TB disease. People with active TB disease feel sick. They may also be able to spread the germs to people they spend time with every day. Without treatment, active TB disease can be fatal.

If you have active TB disease, you can be treated with medicine. You will need to take several different TB medicines. This is because there are many TB germs to be killed. Taking several TB medicines will do a better job of killing all the TB germs and preventing them from becoming resistant to the medicines.

TB germs are strong, and it can take a long time for them to die. Even if you start to feel better, it is important to take and finish all TB medicines exactly as your health care provider recommends:

• If you stop taking the medicines too soon, you can become sick again;
• if you do not take the medicines correctly, the TB germs that are still alive may become resistant to those medicines. TB that is resistant to medicines is harder to treat.

Treatment options

There are several safe and effective treatment plans recommended in the United States for active TB disease. A treatment plan (also called treatment regimen) for active TB disease is a schedule to take TB medicines to kill all the TB germs. Your treatment plan for active TB disease will include:

• The types of TB medicines to take,
• How much TB medicine to take,
• How often to take the TB medicines,
• How long to take the medicines,
• How to monitor yourself for any side effects of your TB medicine, and
• The health care provider(s) who will support you through the treatment process.

You and your health care provider will discuss which treatment plan is best for you depending on your medical history and any medications you are currently taking. Your health care provider will make sure the medications can kill the TB germs in your body.

Treatment for active TB disease can take four, six, or nine months depending on the treatment plan.

The treatment plans for active TB disease use different combinations of medicines that may include:

• Ethambutol
• Isoniazid
• Moxifloxacin
• Rifampin
• Rifapentine
• Pyrazinamide

Four-month treatment plan

Four months of high-dose daily rifapentine with moxifloxacin, isoniazid, and pyrazinamide

Six- or nine-month treatment plans

Six or nine months of rifampin, isoniazid, pyrazinamide, and ethambutol

Before starting treatment

Tell your health care provider about all medicines you are taking.

• Some medicines can interact with the TB medicines and cause a possible side effect or reaction after taking medicine.
• Some oral contraceptives (birth control pills) may not work as well when you take them with medicines for active TB disease.
  • TB medicines can sometimes interfere with birth control pills and possibly make the birth control pills less effective.
  • If you are taking birth control pills, talk with your health care provider before beginning any new medicines.

Tell your health care provider if you are or think you may be pregnant, or are breastfeeding before you start any TB medicines.

Your health care provider can recommend a treatment plan.

Drinking alcoholic beverages while taking medicines for TB can be dangerous and may hurt your liver.

Alcoholic beverages include wine, beer, or liquor. Ask your health care provider about things to avoid while taking medicines for active TB disease.

Side effects

Most people can take their TB medicines without any problems. However, like all medicines, the medicine you take for active TB disease can have side effects.

People react differently to medicines. Tell your health care provider about anything you think is wrong.

Some side effects are minor.

For example, any TB medicine can cause a skin rash. Other TB medicines may cause an upset stomach or nausea. Taking your TB medicine with food can help your body absorb the medicine better.

The rifampin or rifapentine medicines may cause some body fluids, to turn an orange color, such as:

• Urine (pee),
• Saliva,
• Tears,
• Sweat, and
• Breast milk.

This is normal and harmless. The color may fade over time. Your health care provider may tell you not to wear soft contact lenses because they may get permanently stained.

If you have any of these side effects, you can continue taking your medicine.

Other side effects are more serious.

If you have a serious side effect, call your health care provider immediately. You may be told to stop taking your medicines or to return to the clinic for tests. Serious side effects include:

• Liver injury
  • Abdominal pain
  • Nausea and vomiting
  • Skin and eyes turning yellow (also called jaundice)
• Dizziness or lightheadedness
• Loss of appetite
• Flu-like symptoms
• Tingling or numbness in your hands or feet

If you are taking isoniazid, you may have tingling or numbness in your hands and feet. Your health care provider may add vitamin B6 to your treatment plan to prevent this.

Special considerations

Children

Treatment for active TB disease in children may take four months, six months, or longer. Health care providers will consider a child's age, weight, and other factors when prescribing treatment.

The active TB disease treatment plans for children include:

• Four months of high-dose daily rifapentine with moxifloxacin, isoniazid, and pyrazinamide is recommended for children who are 12 years and older and who weigh at least 40 kilograms.
• Six or nine months of rifapentine, isoniazid, pyrazinamide, and ethambutol (also called RIPE) is recommended for children of any age.

People with HIV

There are several TB treatment options for people with HIV and active TB disease. Your health care provider will help make sure your TB medicines do not interfere with your HIV medicines.

Pregnant people

People who are diagnosed with active TB disease during pregnancy should start treatment right away. Your health care provider will choose TB medicines that are recommended for use during pregnancy. Although the TB medicines used in recommended treatment plans cross the placenta, these medicines are not known to have harmful effects on the baby.

Your health care provider will monitor you and your baby during treatment for active TB disease. Tell your health care provider if you have any problems taking your medicine.

Completing treatment

Treating active TB disease takes several months. Your health care provider will work with you to make sure you can complete your treatment.

It takes a long time for the medicines to kill all the TB germs. You will probably start feeling well after only a few weeks of treatment, but beware! The TB germs are still alive in your body, even if you feel better. You must continue to take your medicines until all the TB germs are dead, even though you may feel better and have no more symptoms of TB disease.

If you become infectious again, you could give TB germs to your family, friends, or anyone else who spends time with you.

You may take your medicine through directly observed therapy (DOT), on your own, or a combination of both.

Directly observed therapy (DOT) is the best way to remember to take your TB medicines.

Through DOT, you will meet with a health care worker every day or several times a week. These meetings may be in-person or virtual (through a smartphone, tablet, or computer). The health care worker will watch you take your TB medicines and make sure that the TB medicines are working as they should.

If you take TB medicines on your own

If you take TB medicines on your own, here are tips to help you to remember to take your TB medicines:

• Take your pills at the same time every day—for example, you can take them before eating breakfast, during a regular coffee break, or after brushing your teeth.
• Set an alarm for the time you need to take your medicine.
• Write yourself a note as a reminder to take your medicine. Put it in a place where you can see it, like on your bathroom mirror or on your refrigerator.
• Ask a family member or a friend to remind you to take your pills.
• Mark off each day on a calendar as you take your medicine.
• Put your pills in a weekly pill dispenser that you keep by your bed or in your purse or pocket.
• Use a medicine tracker to organize and manage your pills.

NOTE: Remember to keep all medicine out of reach of children.

If you forget to take your pills one day, skip that dose and take the next scheduled dose. Tell your health care provider that you missed a dose. You may also call your health care provider for instructions.

Talk to your health care provider if you have any questions or concerns about treatment for active TB disease.

Your health care provider will monitor your treatment.

Your health care provider will ask you about side effects and perform tests to see how the medicines are working. Depending on your treatment plan, your health care provider may ask for blood, sputum (phlegm), or urine tests while you are on treatment. These tests help show if the TB medicines are working the right way and how your body is handling the medicine. You may also get additional chest x-rays.

If you have active TB disease and other health problems, like HIV infection or diabetes, you may need to have blood, sputum (phlegm), or urine tests before and after treatment.

Be sure to keep your clinic appointments and talk to your health care provider if you have any problems with your medicines.

Keep a record of your treatment.

Even after you finish taking all of your medicine for active TB disease, you may still have a positive test result on future TB blood tests or TB skin tests.

Ask your health care provider for a written record that you have finished treatment for active TB disease. This will be helpful if you are asked to have another TB test in the future.

Most healthy people will not need to be treated for active TB disease ever again.

However, the treatment you completed only kills the TB germs in your body now. If you are around someone with active TB disease, there is a chance that you can get new TB germs in your body.

Getting support

It is very important to take and finish all TB medicines exactly as prescribed by your health care provider. Talk to your health care provider if you have any questions or concerns about treatment for active TB disease. Tell your health care provider if you:

• Have side effects from the TB medicine.
• Need help taking your TB medicine.
  • This includes food, clean water, or transportation.

If you need additional assistance or support in completing treatment for active TB disease

Talk to your health care provider.

The state or local TB program may be able to provide support or have resources to help you.

Ask your family or friends for support.

If you need support while completing treatment for active TB disease, ask your family or friends. A family member or friend can help you to remember to take your TB medicines. It can be hard taking TB medicine for several months. A family member or friend can provide emotional support and may be able to help you get resources such as food and groceries if you have to stay away from others while being treated for active TB disease.

Connect with other TB survivors.

We are TB, and Somos TB for Spanish-speakers, is a community of TB survivors, people being treated for TB, and their family members, committed to the common goal of eliminating TB. The group provides comprehensive peer support for current TB patients and TB clinics.

You can learn about people's experiences of being diagnosed and treated for active TB disease through CDC's Tuberculosis Personal Stories.

Resources