Generally, there are two types of tuberculosis, active tuberculosis and latent tuberculosis. Active tuberculosis simply means patients are having signs and symptoms of tuberculosis such as dry cough, night sweats and fever, while latent tuberculosis lacks these symptoms but show positive results on the tuberculin skin test or known as Mantoux test.
Treating active and latent tuberculosis requires different strategies and methods. Generally, tuberculosis treatment is started once the patient is diagnosed with various investigations such as chest x ray, sputum acid fast bacilli and sputum culture and sensitivity.
Basically, treatment of tuberculosis follows two main phases called the intensive phase and maintenance phase. Intensive phase is for about 2 months with at least 4 susceptible drugs and the maintenance phase will be about 4 phases for at least 2 drugs of anti tuberculosis.
Total duration of treatment for pulmonary tuberculosis is 6 months, however, other tuberculosis such as tuberculosis meningitis, tuberculosis arthritis and other extrapulmonary tuberculosis will require longer treatment duration for about 9 to 12 months.
- Isoniazid : This is a first line anti tuberculosis commonly used in all types of tuberculosis. Common side effects of these specific drugs are skin rashes and hepatitis. Liver function tests will be usually ordered by your doctor once you are started with this medication. Severe transmintis or seven skin reactions such as Steven Johnson Syndrome or Toxic Epidermal Necrolysis are indications to stop this drug immediately.
- Rifampicin : It is also commonly called as rifampin and used in many other diseases such as osteomyelitis. Common side effects of this medication are abdominal pain, nausea, vomiting, hepatitis, and thrombocytopenic purpura. In order to evaluate compliance of patients towards this drug, doctors often access your urine colour, as rifampicin can make your urine look orange.
- Ethambutol : This is also a first line drug used in treating tuberculosis. Common side effects are retrobulbar neuritis, and ocular side effects, thus please report to your doctor immediately if you have any eye symptoms such as blurring of vision and floaters in eyes.
- Pyrazinamide : Side effects of this drug are joint pain and hepatitis. Similar liver function tests are taken to evaluate your liver function to prevent any critical complications from these side effects,
- Streptomycin : This drug is commonly associated with vestibular and hearing nerve damage and sometimes renal damage as well.
- Kanamycin : This is a second line anti tuberculosis drugs associated with vertigo (spinning sensation), hearing nerve damage and renal damage. Second line antituberculosis drugs can be bought at pharmacy.
Treatment of latent tuberculosis
Not all latent tuberculosis patients are treated, several investigations will be ordered to identify your risk factors. One of the most essential tests to be done is the tuberculin skin test and determining the measurement.
Drugs for treatment of latent tuberculosis are similar to active tuberculosis such as isoniazid, rifampicin, pyrazinamide and ethambutol. However you are expected to be given shorter regimes than usual.
Treatment of tuberculosis during pregnancy
Untreated tuberculosis in pregnant women is hazardous as it can cause danger to both the mother and her fetus.
- Infants born to mothers with moderate to high probability of tuberculosis may be lower birth weight and in rare occasions, the infant may be born with tuberculosis.
- Even though drugs used in the intensive phase of tuberculosis treatment can cross the placenta, they do not necessarily bring harmful effects to the fetus.
- The preferred treatment regime is isoniazid, rifampicin, and ethambutol taken daily for 2 months and followed by isoniazid, and rifampicin daily for 7 months. This brings the total duration of treatment to be 9 months.
- Streptomycin is contraindicated to be used as it may cause harmful effects to the fetus.