TB treatment: what the months ahead look like

TB most often affects the lungs, and its symptoms build slowly enough that people frequently put them down to something else for weeks.

• A cough lasting more than two weeks.
• Coughing up blood or blood-stained sputum.
• Drenching night sweats.
• Unintended weight loss.
• Fever, and tiredness that does not lift.
• Chest pain, or breathlessness.

Standard treatment for drug-sensitive TB runs for about six months, in two phases. The intensive phase uses a fixed-dose combination such as rifampicin / isoniazid / pyrazinamide / ethambutol (rhze fdc) (Rimstar 4-FDC); the continuation phase steps down to fewer medicines, often rifampicin / isoniazid (rh fdc).

The length is not caution for its own sake. TB bacteria divide slowly and some persist in a dormant state that short courses do not reach. Most people feel substantially better within a few weeks — long before the infection is actually cleared.

• rifampicin turns urine, tears and sweat orange-red. This is harmless and expected, but it will stain soft contact lenses.
• pyridoxine (vitamin b6) is given alongside treatment to prevent nerve problems caused by one of the TB medicines. Take it as prescribed.
• Nausea is common early on. Taking tablets with a small amount of food, unless told otherwise, usually helps.
• You will be asked to give sputum samples during treatment to confirm it is working.
• Rifampicin makes hormonal contraception less reliable — use an additional method and discuss it with the clinic.

TB spreads through the air when someone with untreated lung TB coughs, sings or talks. Once effective treatment starts, infectiousness drops quickly — usually within a couple of weeks — which is another reason early treatment matters to everyone in the house.

• Cover your mouth when coughing, and open windows. Ventilation matters more than disinfecting surfaces, because TB is airborne.
• Household contacts should be screened, and children and people living with HIV may be offered preventive treatment such as isoniazid (inh) — tb preventive therapy.
• Sleep in a well-ventilated room, separately if that is possible, during the early weeks.
• TB is not spread by sharing food, utensils, bedding or handshakes.