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Treating Drug-Resistant Tuberculosis

Topic Overview

People infected with tuberculosis (TB) bacteria that are antibiotic-resistant need special treatment programs. People with a weakened immune system are more likely to get drug-resistant TB. These include people infected with HIV or people who have had an organ transplant.

Treatment usually involves at least four medicines.1

  • A treatment program using four to six medicines appears to be best. The choice of medicines depends on the results of sensitivity testing.
  • Most treatment programs involve isoniazid, rifampin, and pyrazinamide, along with one to three second-choice medicines.
  • Second-choice medicines used to treat drug-resistant TB usually have more side effects than the first-choice medicines. Second-choice medicines include streptomycin, capreomycin, ethionamide, kanamycin, ofloxacin, para-aminosalicylic acid, and rifabutin.
  • It is very important to take every dose of medicine. So directly observed therapy (DOT) usually is done. During DOT, a health professional watches you take every dose of medicine.
  • Treatment is continued until TB bacteria can no longer be found in two sputum samples taken a month apart. This may take 18 months or longer in people with multidrug-resistant TB (MDR-TB).

Some TB bacteria have become resistant to all of the antibiotics that are commonly used to treat TB. This is sometimes called totally resistant tuberculosis (TDR-TB).2 A TB infection of this type is very difficult to treat.

References

Citations

  1. American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America (2003). Treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167(4): 603–662.
  2. Cegielski P, et al. (2012). Challenges and controversies in defining totally drug-resistant tuberculosis. Emerging Infectious Diseases [Internet], November. Available online:

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care Medicine, Medical Toxicology
Last Revised April 4, 2013

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