Tuberculosis Treatment: Understanding Effective Options, Strategies, and Insights

Tuberculosis, or TB, is a disease that is caused by TB germs, specifically a bacterium called Mycobacterium tuberculosis. This disease primarily affects the lungs but may also affect other body parts, including lymph nodes, brain, kidneys, bones, and joints. Tuberculosis can be active or latent (without visible symptoms), and some strains of TB can be drug-resistant, which are hard to treat. TB infection is curable with proper treatment, including antibiotics that kill TB-causing bacteria.

Mycobacterium tuberculosis is transmitted through the air as the person infected with TB coughs, sneezes, or talks; the released droplets contain bacteria. People with a weak immune system and those suffering from HIV/AIDS are at a greater risk of developing active tuberculosis. Other risk factors include age (young and elderly people), certain medical conditions, and severe kidney disease. Close contact with the infected person increases the risk of infection and acquiring TB infection.

Diagnosis of TB involves detecting both active and inactive TB, Mycobacterium tuberculosis. Generally, TB tests, including the blood test, are performed to diagnose TB bacteria; however, in some cases, additional tests such as lab tests and X-rays may be performed to detect active and latent TB disease. Skin tests can also help diagnose TB infection. Some other tests may be performed to confirm the presence of infection and drug resistance.

Some tests performed to diagnose tuberculosis are:

• Miroscopy
• Culture
• Molecular tests
• Blood tests
• Skin test
• Chest X-rays

Mainly, there are two types of tuberculosis infections: latent TB infection, which does not involve any symptoms, and active TB disease, which involves common symptoms. Further, there are some other types of tuberculosis disease.

The infection does not involve symptoms as the bacteria are inactive and are not contagious, but the bacteria may become active if the immune system becomes weak.

The infection is contagious and affects the lungs and other parts of the body, leading to various TB symptoms. The infection can be transmitted to healthy people through coughing, sneezing, and speaking. Active TB has many types, including:

• Pulmonary Tuberculosis (symptoms include coughing, difficulty breathing, and chest pain).
• Extrapulmonary Tuberculosis (spread from lungs to kidneys, brain, spine, and lymph nodes).
• Military Tuberculosis (a rare type of TB that spreads through the bloodstream and marks other organs).
• Drug-Resistant Tuberculosis (MDR-TB and XDR-TB, which is more difficult to treat).

It's extremely important to take measures to prevent TB, especially for those with weakened immune systems and latent tuberculosis infection. TB prevention involves multiple approaches, such as good hygiene practices, latent TB infection treatment, ensuring adequate ventilation, diagnosing and treating active TB infection to prevent active TB disease transmission to others. 

Moreover, the TB vaccines, such as the BCG vaccine, can also prevent TB in some people; however, the effectiveness of this vaccination varies. Whether you are suffering from an active TB infection or a latent TB infection, the role of a healthcare professional is irreplaceable as they can help you diagnose the type of infection, recommend accurate treatment, and other lifestyle modifications.

The first thing is treating latent tuberculosis infection, where the TB bacteria exist in your body but in an inactive form without causing any symptoms. The bacteria can become active later, so it's vital to take necessary medications to prevent the latent TB progression to active TB.

Hygiene plays a crucial role in TB treatment as it spreads through the air. Infected people should cover their nose and mouth while coughing and sneezing to prevent spreading the infected droplets. Dispose of the used tissues properly and wash your hands frequently to minimize the risk of spreading infection.

Ventilation allows proper airflow to decrease the concentration of TB bacteria in the air. So make sure wherever you are, there is proper ventilation and the air quality is good.

If you have symptoms of active tuberculosis infection that include persistent cough, weight loss, night sweats, and fever, seek medical attention as soon as possible to ensure proper diagnosis and treatment.

People suffering from active TB infection can easily spread the infection to other people in their home, office, or surroundings. To prevent spreading the infection, it's better to isolate yourself at home to avoid direct contact with other people until you get better.

Take all the TB medicines prescribed as suggested by your doctor for the prescribed duration to prevent drug resistance and ensure successful treatment.

Drug-resistant TB infection develops as the tuberculosis bacteria become resistant to one or multiple medications, making the germs spread and the treatment process more challenging. The resistance may occur due to many different reasons, such as improper management of TB medications or misuse of TB drugs.

Generally, the patients who have already received TB treatment and those who have been exposed to drug-resistant variants of TB are at greater risk of developing TB drug resistance. For drug-resistant tuberculosis, your healthcare provider needs to do proper treatment planning and careful monitoring.

When patients do not take the TB medications for the recommended period and do not complete the treatment, or if patients take the wrong dosage, the drug-resistant strain of bacteria can emerge.

Not getting the medicines on time, incorrect prescriptions, and improper management of drug side effects cause drug resistance.

Just like the active TB infection, drug-resistant TB spreads the same way through the air as the infected individual coughs, sneezes, or talks.

Drug resistance makes the TB treatment more complex and challenging, contributing to a higher risk of side effects and expensive treatment plans. Drug-resistant tuberculosis leads to higher mortality rates compared to drug-susceptible tuberculosis disease. Improper management of drug-resistant TB can spread the infection, leading to outbreaks.

Tuberculosis treatment options are based on the form of TB, whether it's latent or inactive tuberculosis, along with the existence of drug resistance. Typically, tuberculosis TB treatment involves antibiotics combined with treatment regimens for months. Moreover, DOT or directly observed therapy plays a major role in TB treatment as it ensures that patients are getting their medications accurately as prescribed.

In case the TB is drug-susceptible,  typically a 6-month antibiotic course is prescribed in two phases: the initial intensive phase and then the continuation phase. In case of drug-resistant TB, a more complex treatment is prescribed involving four drugs that are Maxifloxacin, Linezolid, Pretomanid, and Bedaquiline. Along with these treatment regimens, directly observed therapy is usually used to ensure the patients adhere to the prescribed treatment plan.

• Typical 6-month medication regimen (Rifampicin, Isonazid, Ethambutol, and Pyrazinamide)
• Shorter treatment regimens (1-3 months)
• Antituberculosis Medications (Ethambutol, Pyrazinamide, Rifapentine, Rifabutin, Rifampin, Isonazid)
• Directly Observed Therapy (ensure adherence to the recommended treatment)

• Complex treatment for a longer duration
• Individualised treatment plan
• Four-drug combination regimen (Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin).
• Drug Observed Therapy to ensure adherence to the treatment.
• Depending on the type of drug resistance, some other medicines may be prescribed, such as Capremycin, Kanamycin, Amikacin, or Fluoroquinolones.

Tuberculosis treatment involves medications along with a comprehensive approach, including medical, physical, emotional, nutritional as well and social support. Healthcare professionals offer crucial care and support to patients suffering from TB in terms of counselling, treatment, and monitoring, which is essential for disease control and prevention. The ongoing care and support ensure successful treatments and complete recovery. TB treatment requires a patient-focused approach targeting the individual needs of the patients, ensuring adherence to the treatment and desired outcomes.

Diet plays a crucial role in your health, as well as in TB treatment. TB patients require proper nutritional assessment and guidance for recovery and to restore good health.

Proper counselling and support from your family and friends are essential to address the social challenges and emotional trauma associated with tuberculosis, as recommended by the World Health Organization, allowing patients to cope with the condition.

Early diagnosis of tuberculosis and its proper treatment are vital for preventing the transmission and also reducing the risk of developing drug resistance. The success of TB treatment and prevention of drug resistance completely depends on adherence to the recommended treatment plan. Moreover, TB patients need to be monitored closely by a healthcare worker in terms of possible side effects, adherence to the treatment, and drug resistance according to guidelines set by the Centers for Disease Control.