General: A combination of antibiotics is typically prescribed for six to 12 months. The exact drugs and length of treatment varies, depending on the patient's age, overall health and state of the disease (latent or active). While the antibiotic rifabutin is used to treat TB in patients who do not have HIV, this drug should not be used to treat HIV patients who are also taking the protease inhibitor saquinavir or the non-nucleoside reverse transcriptase inhibitor delavirdine.
Latent TB: HIV patients who have latent TB have been treated with a daily dose of isoniazid (INH) in order to prevent an infection. Treatment generally lasts about six to nine months. Healthcare physicians monitor patients undergoing treatment closely because side effects may cause life-threatening liver disease. Patients are advised not to take acetaminophen (Tylenol®) and to limit alcohol consumption to decrease the risk of liver damage.
Active TB: Patients diagnosed with active TB typically receive a combination therapy of four antibiotics - isoniazid, rifampin (Rifadin®, Rimactane®), ethambutol (Myambutol®) and pyrazinamide. Some of these drugs may be available in a single combination tablet, which helps make the treatment regimen less complicated. For instance, Rifater® contains isoniazid, rifampin and pyrazinamide. While rifabutin (Mycobutin®) is also used to treat TB in patients who do not have HIV, this drug should not be used to treat HIV patients who are taking the protease inhibitor saquinavir or the non-nucleoside reverse transcriptase inhibitor delavirdine because there is an increased risk of serious side effects like uveitis (inflammation of the inner eye). Treatment generally lasts between six and 12 months.
Astragalus: One clinical trial suggests the potential for benefit of astragalus in patients with TB. Further well-designed clinical trials are required before recommendations can be made.
Beta-sitosterol: Beta-sitosterol and beta-sitosterol glucoside have been studied for the adjunct treatment of tuberculosis with antituberculosis regimens. Only one randomized controlled trial, which included a small number of patients, studied beta-sitosterol and beta-sitosterol for this indication. Larger populations of patients with tuberculosis should be evaluated in randomized controlled trials if conclusions are to be made.
L-carnitine: A preliminary study suggests anti-bacterial activity may be increased in patients with tuberculosis given acetyl-L-carnitine. Well-designed clinical trials are required before recommendations can be made.
Probiotics: As a bacterial reservoir, the nose may harbor many varieties of potentially disease-causing bacteria. There is limited evidence that probiotic supplementation may reduce the presence of harmful bacteria in the upper respiratory tract. More studies are needed to establish this relationship and its implications for health.
Results are mixed regarding the ability of probiotics to reduce infective complications of medical treatment. Reduced incidence of infection has been seen in patients treated for brain injury, abdominal surgery and liver transplantation. Other studies have shown no such reduction in elective abdominal surgery and critical care patients.
HIV-infected patients are encouraged to have a tuberculin test (TB skin test) each year.
Patients who test positive for latent TB, but have no evidence of active TB may consider the baccillu Calmette-Guerin (BCG) vaccine. This vaccine is rarely used in the United States, but it is widely available in areas with high TB infection rates. This is because the vaccine is not very effective in adults. However, it can prevent the infection from spreading outside of the lungs in infants. Patients who receive the vaccine will have false-positive TB skin test results.
Avoid close contact with individuals who are infected with TB.