Tuberculosis (TB) Treatment: Medicines, Side Effects and Why You Must Finish the Course

A cough that does not go away for weeks, fever in the evenings, drenching night sweats and weight loss. Tuberculosis (TB, tapedic, or sil) is still one of the leading infectious killers in Pakistan, which is among the countries with the highest number of cases in the world. The encouraging news is that TB is curable, as long as the full course of treatment is taken. The danger is that stopping early, even by a few weeks, can create drug-resistant TB, which is far harder to treat.

This guide explains the symptoms, how TB spreads, how the treatment works, what the standard medicines do and their side effects, why you must finish the course, and how to protect your family.

What is TB?

TB is an infection caused by a bacterium that mostly attacks the lungs (pulmonary TB), but can also affect the lymph glands, bones, spine, brain, intestines and other organs. It spreads through the air when a person with lung TB coughs, sneezes, or speaks. It does not spread through shared utensils, handshakes or clothes.

Symptoms

• Cough for more than two to three weeks, sometimes with phlegm or blood.
• Fever, especially in the evening, and night sweats.
• Unexplained weight loss, loss of appetite and tiredness.
• Chest pain, or breathlessness.
• Swollen glands in the neck (TB of the lymph nodes), back pain (spinal TB), or persistent headache with vomiting (TB meningitis), depending on the site.

A long cough is not always TB. For other causes, read our guide to dry cough vs wet cough. But any cough lasting three weeks needs testing.

Who is at higher risk?

• People living with someone with infectious TB.
• Crowded, poorly ventilated homes and workplaces.
• People with diabetes, HIV, kidney disease or malnutrition. See our guide to diabetes medicines.
• Smokers, and people who use steroid medicines or immune-suppressing drugs for a long time.
• Health workers, and children under five in close contact.

How is it diagnosed?

• Sputum tests (smear and GeneXpert, which also checks for rifampicin resistance), and sometimes culture.
• Chest X-ray.
• Tests on tissue, fluid or lymph node samples for TB outside the lungs.

Government TB centres under the National TB Programme provide tests and treatment free of charge. Ask your doctor or visit the nearest centre.

Treatment: how it works

Drug-sensitive TB is treated with a combination of antibiotics, taken daily, usually for six months:

• Intensive phase (first two months): four medicines: rifampicin, isoniazid, pyrazinamide and ethambutol.
• Continuation phase (next four months): usually rifampicin and isoniazid.

Many patients take fixed-dose combination tablets, in which several medicines are in one tablet, such as Rifin Forte, Rimthree FDC, and Myrin-P Forte. They reduce the number of tablets and the risk of taking only one drug, which can create resistance. Single-drug products include Pyrazid and Rimactal-INH. TB of the spine or brain, and certain other forms, may need longer courses. Your doctor decides the plan.

These are prescription medicines. See the tuberculosis category. If you have a prescription, upload it here.

Taking TB medicines correctly

• Take them every day, on an empty stomach, about an hour before food, or two hours after, as your doctor advises. If nausea is a problem, ask whether you may take them with a light snack.
• Do not miss doses. Use a card or a reminder, and have a family member watch you take them (DOT).
• Finish the whole course, even when you feel well after a few weeks. Feeling better does not mean the bacteria are gone.
• Never stop or change on your own. Incomplete or irregular treatment is the main cause of drug-resistant TB (MDR-TB), which needs longer, harsher treatment.
• Do not borrow or share TB medicines.
• Keep your follow-up visits and tests.

Side effects and what to do

• Orange or red urine, tears and sweat: a harmless effect of rifampicin. It can stain contact lenses and clothes.
• Nausea and loss of appetite: common in the first weeks. Talk to your doctor about timing and remedies.
• Tingling or numbness in the hands and feet: isoniazid can irritate nerves. Doctors usually give vitamin B6 (pyridoxine) with it.
• Joint pain: pyrazinamide can raise uric acid. Read our guide to gout and uric acid medicines.
• Vision changes (blurred vision, difficulty seeing red or green): ethambutol can affect the optic nerve. Stop and tell your doctor right away.
• Liver problems: yellow eyes or skin, dark urine, pale stool, severe nausea, vomiting or belly pain. Stop the medicines and see a doctor immediately. Liver tests may be needed.
• Rash or fever: report promptly.

Important interactions

• Alcohol increases liver risk, so avoid it.
• Rifampicin reduces the effect of many medicines, including the contraceptive pill, some diabetes tablets, blood thinners such as warfarin, anti-seizure medicines and steroids. Tell every doctor that you are on TB treatment, and use another method of contraception. See our guides to blood thinners and epilepsy medicines.
• Do not take antacids at the same time as some TB medicines. Ask your pharmacist about spacing.

Drug-resistant TB

When the bacteria resist rifampicin and isoniazid (MDR-TB), treatment uses second-line medicines for 9 to 20 months, some by injection, with more side effects. These medicines, including cycloserine (for example Bioral 25 mg), are used only by specialists in designated centres. This is why completing first-line treatment matters so much.

Protect your family and community

• Cover your mouth when coughing, and wear a mask when near others in the first weeks of treatment.
• Keep rooms well ventilated, and open windows. Sunlight and fresh air help.
• Do not spit in public. Dispose of sputum safely.
• Family members, especially children, and close contacts should be screened. Children under five in close contact may be given preventive treatment.
• Most people become non-infectious after a couple of weeks of regular treatment, but follow your doctor’s guidance.
• The BCG vaccine in infancy protects young children from severe forms of TB.

Eating and getting stronger

• Eat protein-rich foods: eggs, milk, dahi, chicken, fish, daal and nuts, with fruit and vegetables.
• Drink plenty of fluids, and rest when needed.
• Do not smoke, and avoid alcohol.
• Ask about a multivitamin and vitamin D. See our guide to vitamin D deficiency in Pakistan.
• TB carries stigma. Remember that it is a curable illness, and not a shame. Support from family matters.

When to see a doctor

• Cough for three weeks or more, blood in sputum, evening fever, night sweats or weight loss.
• Child with long-lasting fever, poor weight gain or cough, especially after contact with a TB patient.
• Any side effect described above, especially jaundice or vision changes.
• Missed doses for more than a few days.
• Coughing up a lot of blood, severe breathlessness or chest pain. This is an emergency.

Frequently asked questions

Is TB hereditary?

No. It is an infection, not an inherited disease.

Can TB be cured completely?

Yes, drug-sensitive TB is cured in over 90 per cent of people who finish treatment.

Can I breastfeed with TB?

Generally yes, once treatment has started, with precautions such as a mask. Your doctor will advise.

Can I work or go to school?

Most people can return after a short period of treatment, when the doctor confirms that they are no longer infectious.

Order prescribed TB medicines from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or chest specialist. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.