Tuberculosis Prevention and Treatment

treatment

Healthcare professionals recommend seeing a doctor immediately if fever, unexplained weight loss, night sweats, and a persistent cough is present. These are often signs of active tuberculosis (TB) but may also result from other medical problems, such as human immunodeficiency virus (HIV), and cancer. If an individual does not have a doctor, the local public health department can help in this matter.
If a positive TB test is encountered, but not active disease, a doctor may recommend preventive drug therapy to destroy dormant bacteria that might become active in the future. The individual will likely receive a daily dose of isoniazid (INH). For treatment to be effective, the individual usually takes INH for six to nine months. Long-term use can cause side effects, including the life-threatening liver disease hepatitis. A doctor will monitor the individual's liver function closely while taking INH. It is best to avoid using acetaminophen (Tylenol) and avoid or limit alcohol while taking INH, due to an increase in liver problems.
Active TB treatment: If an individual is diagnosed with active TB, they will usually begin taking four medications, including isoniazid (Nydrazid® or INH), rifampin (Rifadin®), ethambutol (Myambutol®), and pyrazinamide. This regimen may change if susceptibility tests later show some of these drugs to be ineffective. Depending on the severity of the disease and whether there is drug resistance, one or two of the four drugs may be stopped after a few months.
Rifater® is recommended in the initial phase of short-course therapy, which is usually continued for two months. Rifater® is a combination antibiotic used to treat the initial phase of active TB. After a two-month period, a doctor may prescribe another combination of anti-tuberculosis drugs (Rifamate), which can be continued for longer periods.
Rifamate® contains isoniazid and rifampin. This makes therapy less complicated while ensuring that the individual gets the different drugs needed to completely destroy TB bacteria. Rifamate® has caused severe, even fatal, liver problems, such as hepatitis or inflammation of the liver.
Liver problems may increase with age, medication use (prescription, non-prescription, and drugs of abuse), and with daily use of alcohol. Signs of hepatitis include unusual fatigue, weakness, general feeling of discomfort, loss of appetite, nausea, vomiting, dark urine, yellowing of the skin or eyes, or abdominal pain. Healthcare providers recommend seeing a doctor immediately if these symptoms occur. A doctor will monitor liver function routinely if taking Rifamate® or other drugs used for TB treatment.
Rifapentine (Priftin®) is another antibiotic used to treat pulmonary tuberculosis (TB). Rifapentine must only be used in combination with at least one other anti-TB drug, such as rifampin (Rifadin®). Rifapentine is taken twice a week for two months with no less than three days (72 hours) between doses, plus other daily medications as directed during this intensive phase of the treatment. It is critical that not one dose of rifapentine or other medications during this two-month intensive phase of treatment is missed to make sure that TB disappears from the saliva and to make sure that TB does not return.
After the first two months, rifapentine is taken once a week in combination with at least one other prescribed anti-TB drug.
Healthcare providers recommend that drugs for TB should be taken on an empty stomach, either one hour before or two hours after a meal, with a full glass of water. Wait at least one hour before taking an antacid, as antacids may interfere with the drug. Common side effects of anti-TB drugs may include diarrhea, dizziness, drowsiness, gas, headache, heartburn, stomach upset or cramps, and trouble sleeping.
Because TB bacteria grow slowly, treatment for an active infection is lengthy, usually six to 12 months. After a few weeks, the individual will not be contagious and may start to improve. However, it is essential that all medications prescribed are completed. Stopping treatment too soon or skipping doses can create drug-resistant strains of the disease that are much more dangerous and difficult to treat. Drug-resistant strains that aren't treated can quickly become fatal, especially in individuals with impaired immune systems.
Treating drug-resistant TB: Multidrug-resistant TB (MDR-TB) is any strain of TB that cannot be treated with the anti-TB drugs isoniazid (INH) and rifampin (Rifadin®). Extensive drug-resistant TB (XDR-TB) is a newly developed strain of TB that's resistant to the same treatments that MDR-TB is, and additionally XDR-TB is resistant to three or more of the second-line TB drugs, such as rifapentine.

integrative therapies

Note : Currently, there is insufficient evidence available on the safety and effectiveness of integrative therapies for the prevention or treatment of tuberculosis (TB) infections. The therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.
Strong scientific evidence :
Probiotics: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine by keeping harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. An increasing number of studies support the use of probiotics as a supplement to antibiotic therapy. Probiotic supplementation during a course of antibiotics has been studied for reducing adverse effects of antibiotics in the intestinal environment. This includes reducing growth of Clostridium difficile bacteria, which can lead to colitis, a common complication of antibiotics, especially in the elderly. Some probiotics may also help prevent the development of antibiotic resistance. In acutely ill children, synbiotics have been linked to greater weight gain and fewer bacterial illnesses after antibiotics are ended. The evidence consistently supports supplementation of antibiotics with probiotics.
Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
Good scientific evidence :
Probiotics: Limited evidence with day care children suggests supplementation with Lactobacillus GG may reduce number of sick days, frequency of respiratory tract infections, and frequency of related antibiotic treatments. Fermented milk (with yogurt cultures and L. casei DN-114001) may reduce the duration of respiratory infections in elderly people. More research is needed to make a firm conclusion.
Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
Unclear or conflicting scientific evidence :
Astragalus: Limited available clinical study suggests the potential for benefit of astragalus in patients with tuberculosis. Further well-designed clinical trials are required before recommendations can be made.
Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.
Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied for the adjunct treatment of tuberculosis with antituberculosis regimens. Clinical study is currently limited in this area, and larger populations of patients with tuberculosis should be evaluated.
Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
Blessed thistle: Human research of blessed thistle as a treatment for bacterial infections is currently lacking. Laboratory studies report that blessed thistle (and chemicals contained in blessed thistle, such as cnicin and polyacetylene) may have activity against several types of bacterial infections and no effects on some types. Early studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Further evidence is necessary in this area before a firm conclusion can be drawn.
Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
Chlorophyll: Preliminary evidence suggests that chlorophyll intake during chemotherapy treatment in patients with tuberculosis may improve immune parameters and free radical indices, such as malonic dialdehyde. Additional study is needed in this area.
Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes, or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or agents used to treat diabetes. Avoid if pregnant or breastfeeding.
Cranberry: Limited laboratory research has examined the antibacterial activity of cranberry. Further research is warranted in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
L-carnitine: Preliminary study suggests antibacterial activity may be increased in patients with tuberculosis given acetyl-L-carnitine. Additional research is needed to confirm these findings.
Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
Peppermint: There is currently not enough available scientific evidence to support the use of peppermint for tuberculosis. More research is needed in this area.
Peppermint oil may be safe in small doses, although multiple adverse effects are possible. When used on the skin, peppermint oil has been associated with allergic/hypersensitivity reactions, skin rash/hives/contact dermatitis, mouth ulcers/sores, chemical burn, and eye irritation. Lung injury has occurred following an injection of peppermint oil. Peppermint oil taken by mouth may cause headache, dizziness, heartburn, anal burning, slow heart rate, or muscle tremor. Very large doses of peppermint oil taken by mouth have resulted in muscle weakness, brain damage, and seizure. Peppermint oil should be used cautiously by people with G6PD deficiency or gallbladder disease. Use in infants or children is not recommended due to potential toxicity.
Probiotics: There is limited evidence that probiotic supplementation may reduce the presence of bacterial infections in the upper respiratory tract. More studies are needed to determine the effectiveness of probiotics for this indication.
Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
Propolis: Propolis is a natural resin created by bees to make their hives. Propolis is made from the buds of conifer and poplar trees and combined with beeswax and other bee secretions. Animal and laboratory studies suggest that propolis may be a beneficial treatment for various types of bacterial infections. Additional research is needed to confirm these findings.
Avoid if allergic or hypersensitive to propolis, black poplar (Populas nigra), poplar bud, bee stings, bee products, honey, or Balsam of Peru. Severe allergic reactions have been reported. There has been one report of kidney failure with the ingestion of propolis that improved upon discontinuing therapy and deteriorated with re-exposure. Avoid if pregnant or breastfeeding because of the high alcohol content in some products.
Seaweed, kelp, bladderwrack: Bladderwrack (Fucus vesiculosus) is a brown seaweed found along the northern coasts of the Atlantic and Pacific oceans and North and Baltic seas. Another seaweed that grows alongside bladderwrack is Ascophyllum nodosum, andit is often combined with bladderwrack in kelp preparations. Laboratory research suggests that bladderwrack may have antibacterial activity. However, reliable human studies to support this use are currently lacking in the available literature.
Avoid if allergic or hypersensitive to Fucus vesiculosus or iodine. Avoid with a history of thyroid disease, bleeding, acne, kidney disease, blood clots, nerve disorders, high blood pressure, stroke, or diabetes. Avoid if pregnant or breastfeeding.
Sorrel: There is currently not enough evidence on the proposed antibacterial effects of sorrel. More research is needed.
Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
Soy: It has been suggested that soy may be beneficial for tuberculosis when taken with standard medications. According to early research, soy may improve the process of detoxification, have positive effects on the liver, reduce cell damage, and decrease inflammation. Therefore, soy supplements may allow patients to safely take higher doses of antimicrobial drugs that are used to treat tuberculosis.
Avoid if allergic to soy. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are unclear, and therefore, not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk that was not specifically designed for infants. People who experience intestinal irritation from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast or prostate cancers. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs (e.g. warfarin or aspirin) should check with their doctors before taking soy supplements.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves. Although inconclusive, preliminary evidence suggests that thymus extract may improve effectiveness of antibacterial therapy in patients with tuberculosis. Well-designed clinical trials are required before recommendations can be made.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy or hormone therapy. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding.
Fair negative scientific evidence :
Macrobiotic diet: A macrobiotic diet has been advocated to preserve intestinal health. However, it apparently does not reduce the incidence of antibiotic resistant bacteria, nor infections caused by resistant strains in the gastrointestinal tract, compared to a diet with animal products.
Use cautiously with cancer or other medical conditions without expert planning or supplementation. Avoid in children or adolescents without professional guidance or appropriate supplementation. Avoid in pregnant or lactating women due to potential deficiencies, unless properly supplemented.
Probiotics: Bacterial infection translocation, the passage of bacteria from the gut to other areas of the body where they can cause disease, is of special concern in surgery. Limited evidence suggests that supplementation with probiotics may not reduce this problem.
Probiotics are generally considered to be safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.

prevention

In general, tuberculosis (TB) is a preventable disease. From a public health standpoint, the best way to control TB is to diagnose and treat individuals with TB infection before they develop active disease. Also, careful precautions, such as wearing gloves, gowns, and masks, with individuals hospitalized with TB must be taken.
Immune system health: Healthcare professionals recommend eating a balanced diet, with plenty of fresh fruits and vegetables. Adequate amounts of sleep and exercise regularly also help keep the immune system healthy.
Regular testing: Healthcare professionals recommend getting a Mantoux skin test annually if an individual has human immunodeficiency virus (HIV), cancer, or other conditions that weaken the immune system. Also, routine testing is needed if the individual lives or works in a prison or nursing home, is a healthcare worker, or has a substantially increased risk of exposure to the disease.
Preventive therapy: If an individual tests positive for latent TB infection, but has no evidence of active TB, a doctor may want to start therapy with isoniazid (INH) to reduce the individual's risk of developing active TB in the future. A vaccine called bacillus Calmette-Guerin or BCG, is a weakened form of the tuberculosis bacterium. This weakened form of tuberculosis will not cause a tuberculosis infection or disease since it is weak. Instead, it will help to develop immunity against the tuberculosis disease in the event of exposure to an individual who has tuberculosis. BCG is not widely used in the United States and is more often given in countries where TB is more common. The vaccine is not very effective in adults, although it can prevent TB from spreading outside the lungs in infants. Vaccination with BCG also may cause a false-positive result on a Mantoux skin test.
Finishing medications: For individuals with active TB, taking prescribed medications as directed is the most important step in protecting against re-infection with TB. When treatment is stopped early or doses of medications are skipped, TB bacteria have a chance to develop mutations that are resistant to the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat.
Individuals with active TB: Healthcare providers recommend that individuals with active TB be quarantined. Individuals with active TB should not go to work or school or sleep in a room with other people during the first few weeks of treatment. Also, open the windows whenever possible to let in fresh air. Covering the mouth when coughing, laughing, or sneezing is important. It takes two to three weeks of treatment before individuals are no longer contagious. Wearing a mask when around other people during the first three weeks of treatment may help lessen the risk of transmission.