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.^{footnote 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).^{footnote 2} A TB infection of this type is very difficult to treat.