Treatment for tuberculosis is done with the use of oral antibiotics, such as rifampicin, isoniazid, pyrazinamide, ethambutol or rifapentine, which eliminate tuberculosis from the body. Mycobacterium tuberculosis which causes the onset of the disease.
The medicines used in the treatment are made available free of charge by the SUS, and vary according to the stage of the disease and the person’s age, and, therefore, must be recommended by the infectious disease specialist or pulmonologist.
In addition to antibiotics, tuberculosis treatment may involve the use of other medicines, such as vitamin B6 to prevent neurological toxicity, corticosteroids for meningoencephalic tuberculosis, analgesics to reduce fever, or other medicines depending on the symptoms. Check out the main symptoms of tuberculosis.
Main treatments for tuberculosis
Tuberculosis treatment involves the combination of different antibiotics, according to the stage of the disease, with the main treatment schemes being:
1. Rifampicin, isoniazid, pyrazinamid and ethambutol
The basic regimen using the combination of rifampicin, isoniazid, pyrazinamide and ethambutol, is indicated for the initial intensive treatment of pulmonary and extrapulmonary tuberculosis, for adults or children over 10 years of age.
Initial treatment with these antibiotics should be carried out for 2 months, with doses recommended by the doctor, according to body weight. Learn how to use rifampicin, isoniazid, pyrazinamide and ethambutol.
After the initial intensive treatment, maintenance treatment must be carried out.
2. Rifampicin, isoniazid and pyrazinamide
The basic regimen using the combination of rifampicin, isoniazid and pyrazinamide is indicated for the intensive initial treatment or retreatment of pulmonary and extrapulmonary tuberculosis in children under 10 years of age.
This treatment is initially carried out for 2 months, and can be extended for another 10 months, for the maintenance treatment of meningoencephalic tuberculosis, or for another 12 months in the case of extrapulmonary tuberculosis.
The doses of treatment with rifampicin, isoniazid and pyrazinamide must be indicated by the doctor according to the child’s body weight.
In children with malnutrition or HIV infection, supplementation with vitamin B6, or pyridoxine, may also be recommended by the doctor. See how vitamin B6 supplementation is done.
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4. Rifampicin and isoniazid
The combination of rifampicin and isoniazid is indicated for the maintenance treatment of pulmonary and extrapulmonary tuberculosis in adults or children over 10 years of age.
This maintenance treatment is carried out for 6 to 10 months, starting immediately after the initial treatment, with doses recommended by the doctor.
Rifampicin and isoniazid may also be indicated as intensive initial treatment or retreatment of pulmonary and extrapulmonary tuberculosis in children under 10 years of age.
5. Isoniazid, rifampin and rifapentine
Isoniazid, rifampicin or rifapentine are normally indicated for the treatment of latent tuberculosis, which is the phase in which the mycobacteria is “dormant”.
At this stage of the disease, it is very important to undergo treatment, because the disease can become active at any time, making it more difficult to treat.
The doctor usually recommends just isoniazid or rifampicin, or the combination of isoniazid + rifapentine, which should be used for 3 to 9 months until the bacteria are completely eliminated and the result is confirmed through tests.
In the case of bacterial resistance, the doctor may also recommend other types of antibiotics, which depends on which tuberculosis medication the bacteria is resistant to. Understand what bacterial resistance is and how to avoid it.
Treatment of tuberculosis in pregnancy
Tuberculosis treatment during pregnancy is carried out with the same medications used for initial and maintenance treatment in adults, rifampicin, isoniazid, pyrazinamide and ethambutol. However, rifapentine is contraindicated in pregnancy.
Furthermore, due to the greater risk of neurological toxic effects on the fetus, the doctor may recommend pyridoxine (vitamin B6) supplementation for the pregnant woman, at a dose of 50mg/day.
Treating tuberculosis during pregnancy is very important for both the woman and the baby, to reduce the risk of transmitting the disease to the fetus or newborn, as well as to avoid transmitting the disease to other people.
Treatment of tuberculosis during breastfeeding
Tuberculosis treatment during breastfeeding is also carried out with the same antibiotics used for initial and maintenance treatment in adults, and although they can pass in small quantities to the baby through breast milk, there are no contraindications to breastfeeding.
However, it is recommended that women wear a mask when breastfeeding and caring for the baby, as long as the sputum test is positive for the bacillus.
Care during treatment
Some precautions are important during tuberculosis treatment, such as:
- Make appointments with your doctor once a monthto evaluate the symptoms, the evolution of the disease and the side effects of the treatment;
- Perform liver function, kidney function and fasting blood glucose testsbefore starting treatment and when requested by the doctor;
- Take a sputum smear test once a monthfor pulmonary tuberculosis, so that the doctor can evaluate the effectiveness of the treatment;
- Take chest x-rayin cases of pulmonary tuberculosis, when requested by the doctor;
- Follow treatment and take medication at the correct timesas advised by the doctor;
- Do not stop treatment on your owneven after the symptoms have disappeared, to ensure the complete elimination of bacteria;
- Taking medicine after a mealto avoid stomach pain or discomfort, or as per medical advice;
- Isolate in the first 15 days of treatmentas you can still transmit the tuberculosis bacillus to other people;
- Cover your mouth with a tissue or paper when sneezing or coughingand then discard it in a bin with a lid;
- Wear surgical mask when you are close to other people;
- Avoid public areas or closed spacesespecially during the first 2 to 3 weeks of treatment.
Furthermore, in the case of women, during tuberculosis treatment, a barrier contraceptive method must be used, as tuberculosis medicines, especially rifampicin, can reduce the effectiveness of the contraceptive pill.
How to use vitamin D to speed up treatment
Vitamin D was one of the first medicines used to treat tuberculosis before the existence of specific antibiotics to treat the disease. In the past, tuberculosis patients were exposed to sunlight, and although it was not known why sunlight worked, many patients improved.
Currently, vitamin D is known as an important regulator of the immune system that helps defense cells eliminate inflammatory proteins and produce more proteins that actually help eliminate bacteria, such as those that cause tuberculosis.
Therefore, to improve treatment or prevent tuberculosis infection, it is recommended to increase vitamin D levels in the body by eating foods rich in vitamin D and sun exposure with adequate sunscreen and outside the hours of greatest danger.
It is important to highlight that vitamin D may be recommended by a doctor if a person has a vitamin D deficiency, and supplementation with this vitamin does not replace treatment with antibiotics, as it does not eliminate bacteria from the body.
Possible side effects of treatment
The main side effects of tuberculosis treatment are:
- Nausea, vomiting and frequent diarrhea;
- Loss of appetite;
- Yellowish skin;
- Dark urine;
- Inflammation of the optic nerve;
- Uveitis;
- Liver poisoning;
- Increased uric acid, especially in people with gout;
- Acute gouty arthritis;
- Peripheral neuropathy;
- Joint pain;
- Redness, itching and rash.
When side effects appear, it is advisable to inform the doctor who prescribed the medication, to assess whether it is necessary to change the medication or adapt the treatment dose.
Signs of improvement and worsening
Signs of improvement in tuberculosis appear around 2 weeks after starting treatment and include decreased tiredness, disappearance of fever and relief of muscle pain.
Signs of worsening are more frequent when treatment is not started in time, especially in cases of latent tuberculosis in which the person does not know they are infected, and include the appearance of fever above 38º C, general malaise, night sweats and muscle aches.
Furthermore, depending on the affected area, more specific symptoms may also appear, such as coughing up blood, swelling of the affected area or weight loss.
