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30-07-2024 Team Medicover pulmonology

Written by Medicover Team and Medically Reviewed by Dr Veluvarthi Vijay

Tuberculosis Medicines

Tuberculosis (TB) is a serious bacterial infection caused by Mycobacterium tuberculosis. It primarily affects the lungs and can also spread to other parts of the body. With the right medications and by following the doctor's instructions carefully, most people can be effectively treated and cured. It's essential to take the medication for the entire period prescribed by the doctor to ensure the infection is fully cleared.

In this article, we'll explore the best tuberculosis medicines, how they work and the latest developments in TB treatment.

What is Tuberculosis?

Tuberculosis is a contagious infection that spreads through airborne droplets when an infected person coughs or sneezes. While TB mainly targets the lungs, it can also affect other parts of the body like the brain, kidneys and bones. Some common signs of TB include a long-lasting cough, fever, sweating at night, unintentional weight loss and feeling extremely tired.

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Can TB Be Cured with Medications Alone?

TB can be cured with medications alone, especially when diagnosed early and treated with a proper regimen. Most patients are treated with a combination of drugs taken daily over 6 to 9 months. Incomplete or improper treatment can lead to drug-resistant TB, making it much harder to cure.

Top 5 Best Tuberculosis Medicines

First-line anti-TB medications form the foundation of treatment and are typically used in combination. Each has a unique role in killing TB bacteria and preventing resistance.

1. Isoniazid (INH)

Use: This medicine effectively kills the TB bacteria that are currently active in the body.
Dosage: Usually, the dosage is between 5 to 10 milligrams for each kilogram of body weight per day, but not more than 300 milligrams in total.
Benefits: Isoniazid works quickly and is very effective.
Side Effects: It can affect the liver and cause nerve problems but taking Vitamin B6 can help prevent these issues.

2. Rifampin (RIF)

Use: Rifampin is an antibiotic that works against a wide range of bacteria by blocking their ability to make RNA, which is essential for their growth and reproduction.
Dosage: The usual amount is 10 mg for each kilogram of body weight each day with a maximum dose of 600 mg daily.
Benefits: Rifampin is crucial for treating tuberculosis (TB) and is also used for people with latent TB (where the infection is not active but could become so).
Side Effects: Some people may notice that their bodily fluids (like urine and sweat) turn orange. It can also affect the liver and interact with other medications, especially those used to treat HIV.

3. Pyrazinamide (PZA)

Use: Pyrazinamide is a medication used to treat tuberculosis (TB), especially effective in areas of the body where the environment is more acidic like infected tissues.
Dosage: The typical dose ranges from 15 to 30 mg per kilogram of body weight each day.
Benefits: One of the main advantages of using Pyrazinamide is that it can reduce the length of TB treatment from 9 months to just 6 months.
Side Effects: While it can be very effective, Pyrazinamide can also cause some issues. These may include liver problems, pain in the joints and feelings of nausea.

4. Ethambutol (EMB)

Use: Ethambutol is a medication that helps fight infections, particularly in cases where other treatments might not work well due to drug resistance.
Dosage: Doctors typically recommend a dose of 15 to 25 milligrams for every kilogram of body weight each day.
Benefits: This medication can be especially helpful when there's a concern that the bacteria causing an infection may not respond to other drugs.
Side Effects: Some people may experience issues with their vision (known as optic neuritis) or develop a rash.

5. Streptomycin (SM)

Use: Streptomycin is an antibiotic that is given through an injection. It’s not used as much today as it used to be.
Dosage: The typical dose is based on a person’s weight with 15 milligrams for every kilogram of body weight and it's usually administered into the muscle.
Benefits: This medication is helpful for treating serious infections, especially when other treatments don’t work.
Side Effects: While it can be effective, it may come with some side effects like hearing loss and damage to the kidneys.

Second-Line Tuberculosis Medicines

When the common treatments for tuberculosis (TB) don't work, doctors use second-line medicines. These are special drugs used for cases where the TB bacteria have become resistant to the first treatments. Some of these second-line medicines include:

Fluoroquinolones like Levofloxacin and Moxifloxacin are a type of antibiotic.
Injectable drugs like Amikacin and Capreomycin are given with a needle.
Other medicines like Linezolid, Cycloserine and Ethionamide are also used based on the needs of the case.

It is important to know that these second-line drugs can have more side effects, less effective and used for a longer duration up to 20–24 months in some cases.

Drug-Resistant Tuberculosis

What Causes Drug Resistance?

Drug resistance occurs when treatments for tuberculosis (TB) aren't used properly. Here are some common reasons why this happens:

TB medications are not taken consistently
Incorrect dosages are prescribed.
Patients stop treatment earl.y

These issues can make the TB bacteria stronger and harder to treat.

TB Medications for MDR Cases

MDR-TB is a serious form of tuberculosis that doesn't respond to the two most common medications, Isoniazid and Rifampin. To treat this condition, doctors use a combination of newer medicines like:

Bedaquiline
Linezolid
Delamanid
Clofazimine

These medications need to be taken together for a long time up to 9 to 20 months and this treatment should be managed by healthcare professionals with expertise in handling such cases.

WHO Guidelines for Drug-Resistant TB

The World Health Organisation (WHO) suggests some important strategies for treating drug-resistant tuberculosis (TB):

Whenever possible, use treatment plans that do not include injections.
Use newer medications like bedaquiline, which can be more effective.
If there are other options available, avoid using injectable medications.
Make sure patients take their medicine as directed by having healthcare workers watch them take their doses. This method is known as Directly Observed Therapy (DOTS).

These recommendations aim to improve treatment success and help more people recover from drug-resistant TB.

New Medications for TB Treatment

New and Recent advancements in medications have significantly improved TB treatment success rates. Here are some key developments:

Bedaquiline: This new drug works by targeting ATP synthase, a vital part of the bacteria that helps it produce energy.
Pretomanid: This medicine is often used together with bedaquiline and another drug called linezolid in a treatment plan known as the BPaL regimen.
Shorter, 6-month MDR regimens are being trialled and used in select countries.

These new approaches are making it easier to treat this challenging disease.

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Conclusion

Tuberculosis remains a global health challenge, but effective medications exist to cure it completely. First-line drugs like Isoniazid and Rifampin remain the gold standard, while second-line and newer medicines help tackle resistant cases.

The most important factors for a successful recovery are getting diagnosed early, taking the right medications and following the treatment plan closely.

Frequently Asked Questions

Stopping treatment early can lead to drug resistance, treatment failure and disease relapse.

Directly Observed Therapy, Short-Course (DOTS) is a World Health Organisation (WHO)- recommended strategy in which healthcare workers observe patients taking their medications to ensure adherence.

No. TB is a bacterial infection and requires antibiotics for a complete cure. Alternative treatments are not effective.

Standard TB treatment usually lasts 6 months. MDR-TB can require 9–24 months depending on severity and response.

Yes, especially Rifampin, which interacts with HIV medications, birth control and blood thinners. Always inform your doctor about other drugs you’re taking.