Questions and Answers About TB, 2007
Active TB Disease
How is active TB disease treated?
There is good news for people with active TB disease! It can almost
always be treated with medicine. But the medicine must be taken
as the doctor or nurse tells you.
If you have active TB disease, you will need to take several different
medicines. This is because there are many bacteria to be killed.
Taking several medicines will do a better job of killing all of
the bacteria and preventing them from becoming resistant
to the medicines.
The most common medicines used to treat TB are
- isoniazid (INH)
- rifampin (RIF)
If you have active TB disease of the lungs or throat, you are
probably infectious. You need to stay home from work or school so
that you don't spread TB bacteria to other people. After taking
your medicine for a few weeks, you will feel better and you may
no longer be infectious to others. Your doctor or nurse will tell
you when you can return to work or school or visit with friends.
Having active TB disease should not stop you from leading a normal
life. When you are no longer infectious or feeling sick, you can
do the same things you did before you had active TB disease. The
medicine that you are taking should not affect your strength, sexual
function, or ability to work. If you take your medicine as your
doctor or nurse tells you, the medicine should kill all the TB bacteria.
This will keep you from becoming sick again.
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What are the side effects of medicines for
If you are taking medicine for TB, you should take it as directed
by your doctor or nurse. Occasionally, the medicines may cause
side effects. Some side effects are minor problems. Others are more
serious. If you have a serious side effect, call your doctor
or nurse immediately. You may be told to stop taking your medicine
or to return to the clinic for tests.
The side effects listed below are serious. If you have
any of these symptoms, call your doctor or nurse immediately:
- no appetite
- yellowish skin or eyes
- fever for 3 or more days
- abdominal pain
- tingling fingers or toes
- skin rash
- easy bleeding
- aching joints
- 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.
- Rifampin can make you more sensitive to the sun. This means
you should use a good sunscreen and cover exposed areas so you
- Rifampin makes birth control pills and 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 have withdrawal symptoms. Your doctor
or nurse may need to adjust your methadone dosage.
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Why do I need to take TB medicine regularly?
TB bacteria die very slowly. It takes at least 6 months for the
medicine to kill all the TB bacteria. You will probably start feeling
well after only a few weeks of treatment. But beware! The TB bacteria
are still alive in your body. You must continue to take your medicine
until all the TB bacteria are dead, even though you may feel better
and have no more symptoms of active TB disease.
If you don't continue taking your medicine or you aren't taking
your medicine regularly, this can be very dangerous. The TB bacteria
will grow and you will remain sick for a longer time. The bacteria
may also become resistant to the medicines you are taking. You may
need new, different medicines to kill the TB bacteria if the old
medicines no longer work. These new medicines must be taken for
a longer time and usually have more serious side effects.
If you become infectious again, you could give TB bacteria to
your family, friends, or anyone else who spends time with you. It
is very important to take your medicine the way your doctor
or nurse tells you.
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How can I remember to take my medicine?
The only way to get well is to take your medicine exactly as your
doctor or nurse tells you. This may not be easy! You will be taking
your medicine for a long time (6 months or longer), so you should
get into a routine. Here are some ways to remember to take your
- Participate in the directly
observed therapy (DOT) program at your health department.
- Take your pills at the same time every day — for example,
you can take them before eating breakfast, during a coffee break,
or after brushing your teeth.
- Ask a family member or a friend to remind you to take your pills.
- Mark off each day on a calendar as your take your medicine.
- Put your pills in a weekly pill dispenser. Keep it by your bed
or in your purse or pocket.
NOTE: Remember to keep all medicine out of
reach of children.
If you forget to take your pills one day, skip that dose and take
the next scheduled dose. Tell your doctor or nurse that you missed
a dose. You may also call your doctor or nurse for instructions.
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What is directly observed therapy?
The best way to remember to take your medicine is to get directly
observed therapy (DOT). If you get DOT, you will meet with a health
care worker every day or several times a week. You will meet at
a place you both agree on. This can be the TB clinic, your home
or work, or any other convenient location. You will take your medicine
at this place while the health care worker watches.
DOT helps in several ways. The health care worker can help you
remember to take your medicine and complete your treatment. This
means you will get well as soon as possible. With DOT, you may need
to take medicine only 2 or 3 times each week instead of every day.
The health care worker will make sure that the medicine is working
as it should. This person will also watch for side effects and answer
questions you have about TB.
Even if you are not getting DOT, you must be checked at different
times to make sure everything is going well. You should see your
doctor or nurse regularly while you are taking your medicine. This
will continue until you are cured.
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How can I keep from spreading TB?
The most important way to keep from spreading TB is to take all
your medicine, exactly as directed by your doctor or nurse. You
also need to keep all of your clinic appointments! Your doctor or
nurse needs to see how you are doing. You may need another chest
x-ray or a test of the phlegm you may cough up. These tests will
show whether the medicine is working. They will also show whether
you can still give TB bacteria to others. Be sure to tell the doctor
about anything you think is wrong.
If you are sick enough with active TB disease to go to a hospital,
you may be put in a special room. These rooms use air vents that
keep TB bacteria from spreading to other rooms. People who work
in these special rooms must wear a special face mask to protect
themselves from TB bacteria. You must stay in the room so that you
will not spread TB bacteria to other people. Ask a nurse for anything
you need that is not in your room.
If you are infectious while you are at home, there are certain
things you can do to protect yourself and others near you. Your
doctor may tell you to follow these guidelines to protect yourself
- The most important thing is to take your medicine.
- Always cover your mouth with a tissue when you cough, sneeze,
or laugh. Put the tissue in a closed bag and throw it away.
- Do not go to work or school. Separate yourself from others and
avoid close contact with anyone. Sleep in a bedroom away from
other family members.
- Air out your room often to the outside of the building (if it
is not too cold outside). TB spreads in small closed spaces where
air doesn't move. Put a fan in your window to blow out (exhaust)
air that may be filled with TB bacteria. If you open other windows
in the room, the fan also will pull in fresh air. This will reduce
the chances that TB bacteria will stay in the room and infect
someone who breathes the air.
Remember, TB is spread through the air. People cannot get infected
with TB bacteria through handshakes, sitting on toilet seats, or
sharing dishes and utensils with someone who has TB.
After you take medicine for about 2 or 3 weeks, you may no longer
be able to spread TB bacteria to others. If your doctor or nurse
agrees, you will be able to go back to your daily routine. Remember,
you will get well only if you take your medicine exactly as your
doctor or nurse tells you.
Think about people who may have spent time with you, such as family
members, close friends, and coworkers. The local health department
may need to test them for latent TB infection. TB is especially
dangerous for children and people with HIV infection. If infected
with TB bacteria, these people need medicine right away to keep
from developing active TB disease.
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Sometimes the TB bacteria are resistant to the medicines used to
treat TB disease. This means that the medicine can no longer kill
the bacteria. Multidrug-resistant TB, or MDR TB, is bacteria that
are resistant to two or more of the most important TB medicines:
INH and RIF.
A more serious form of MDR TB is called extensively drug-resistant
TB (XDR TB). XDR TB is a rare type of TB that is resistant to nearly
all medicines used to treat TB disease.
If you do not take your medicine as your doctor or nurse tells
you, the TB bacteria may become resistant to a certain medicine.
Also, people who have spent time with someone sick with MDR TB or
XDR TB disease can become infected with these multidrug-resistant
Drug resistance is more common in people who
- have spent time with someone with drug-resistant active TB disease
- do not take their medicine regularly
- do not take all of their medicine as told by their doctor or
- develop active TB disease again, after having taken TB medicine
in the past
- come from areas where drug-resistant TB is common
People with MDR TB and XDR TB disease must be treated with special
medicines. These medicines are not as good as the usual medicines
for TB and they may cause more side effects. Also, people with MDR
TB and XDR TB disease must see a TB expert who can closely observe
their treatment to make sure it is working. Both MDR TB and XDR
TB are very serious problems.