Treatment of TB Disease

In former times, neighbors would shun TB patients because they were afraid of being infected by them. In the past TB was a fatal illness, since there was no effective treatment. The only possible available treatments were taking rest in a place with fresh air and eating nutritious food. The first drug against TB that was discovered was an injection, after that a more oral medicines soon followed. However, the duration of treatment was very long, around one and a half to two years.


At the present time, the treatment of TB disease usually takes 6 months and does not require injection. However, a problem occurred as a result of patients stopping their medication when they began to feel better. After this, the TB disease reoccurred, but this time the TB bacteria were resistant to the old drugs and may be resistant to other drugs as well. The doctor has to look for a new effective drug, which is more expensive. Normally a course of 6 months-treatment costs 3,000 baht, but this increases to approximately 30,000-100,000 baht per patient for the treatment of recurrent TB disease. Moreover, the chance of a complete cure is only 40-50% and the remainder will die.

A Drug-Resistant Tuberculosis Research Fund under the patronage to Her Royal Highness Princess Galayani Vadhana Krom Luang Naradhiwas Rajanagarindra was established. The purposes of this fund are to perform drug susceptibility testing for TB-smear positive patients and to help the physician choose the most suitable drug for treatment of TB disease. Medication is used together with a new strategy called Directly Observed Treatment Shortcourse or DOTS. DOTS needs the participation of family members or friends to remind the patients to take their pills at the same time every day until the full course is finished and the patients cannot spread the germ any more.

The initial recommended treatment for TB disease includes 4 medications taken simultaneously:

  • Isoniazid (INH)

  • Rifampin (RIF)

  • Pyrazinamide (PZA)

  • Ethambutol (EMB)

  • Streptomycin (SM)

The treatment requires multiple medication (using 2 or more drugs) in order to kill bacteria. Each drug has a different action to destroy bacteria. A drug combination is used to prevent the development of a drug-resistant strain of bacteria.

Some serious side effects are: (if you have any of the following side effects, call your doctor or nurse right away)

  • no appetite

  • nausea

  • vomiting

  • yellowish skin or eyes

  • fever for more than3 days

  • abdominal pain

  • tingling in the fingers and toes

  • skin rash, easy bleeding

  • aching joints

  • dizziness

  • tingling or numbness around the mouth

  • easy bruising

  • blurred or changed vision

  • ringing in the ears

  • hearing loss

The side effects listed below are minor problems. If you have any of these side effects, you can continue taking your medicine.

Rifampin can turn urine, saliva, or tears orange. The doctor or nurse may advise you not to wear soft contact lenses because they may get stained. It can make you more sensitive to the sun. This means you should use a good sunscreen and cover exposed areas so you don't burn. Rifampin also makes birth control pills and hormonal implants less effective. Women who take rifampin should use another form of birth control.

If you are taking rifampin as well as methadone (used to treat drug addiction), you may experience withdrawal symptoms. Your doctor or nurse may want to adjust your methadone dosage.

Copyright © 2010 Microbiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University. All rights reserved.