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TB Treatment – Curing TB, TB treatment failure, Surgery

TB treatment

The aims of TB treatment are:

  • To cure the patient of TB and restore their quality of life and productivity;
  • to prevent relapse of TB;
  • to reduce the transmission of TB to others;
  • to prevent the development and transmission of drug resistant TB.1“Treatment of Tuberculosis guidelines”, WHO, Geneva, 2011, 29 www.who.int/tb/en/

Curing TB

TB treatment can cure most people who have TB, using a combination of the different drugs available for TB treatment. Surgery is also occasionally used in the treatment of TB.

TB treatment, the drugs

There are more than twenty drugs available for TB treatment. They are used in differing combinations in different circumstances. So for example, some TB drugs are only used for the treatment of new patients when there is no suggestion of any drug resistance. Others are only used for the treatment of drug resistant TB.2“Treatment of Tuberculosis guidelines”, WHO, Geneva, 2010, 85www.who.int/tb/publications/tb_treatmentguidelines/ More than 90% of people with drug susceptible TB (that is TB which is not drug resistant) can be cured in six months using a combination of “first line” TB drugs.3“The Global Plan to Stop TB”, WHO, Geneva, 2011, vi www.stoptb.org/global/plan/

Killing the TB bacteria

Archbishop Desmond Tutu was treated and cured of TB as a child.

Archbishop Desmond Tutu was treated and cured of TB as a child.

The TB drugs that are taken for the treatment of TB, have the aim of killing all the TB bacteria in the person’s body. This means that the person is cured of TB. However, TB bacteria die very slowly, and so the drugs have to be taken for quite a few months. Even when a patient starts to feel better they can still have bacteria alive in their body. So the person needs to keep taking the treatment until all the bacteria are dead.

All the drugs must be taken for the entire period of TB treatment. If only one or two TB drugs are taken then the bacteria may not all be killed. They may then become resistant to the TB drugs which then don’t work. If the person becomes sick again then different TB drugs may be needed.

TB treatment failure

It is often suggested that TB treatment fails because a patient doesn’t take their TB drugs correctly. However there can be a number of different reasons for TB treatment failure. It is certainly true that if a patient doesn’t take their TB drug treatment properly this can lead to the development of drug resistant TB.¬†However the TB treatment that someone is provided with may result in treatment failure even if the treatment is taken correctly, because the patient may already have drug resistant TB.

In addition to a lack of, or inadequate health infrastructure, the three main causes of TB drug treatment failing relate to the actions of doctors in prescribing incorrect regimes, the fact that there may be problems with the drugs being delivered (either when they are delivered or the quality), and that patients for a number of reasons may not have a sufficient intake of the drugs.4Based on Lambregts-van Weezenbeck, C. S. “Control of drug-resistant tuberculosis” Tubercle and Lung Disease, (1995) 76, 455

Doctors – as a cause of TB drug treatment failure:
Inappropriate guidelines,
Non compliance with guidelines,
Absence of guidelines.
Drugs – as a cause of inadequate TB treatment:
Poor quality,
Irregular supply,
Wrong delivery (dose/combination),
Drugs are unsuitable due to drug resistance.
Patients – as a cause of TB drug treatment failure:
Lack of information,
Lack of money for treatment and/or transport,
Actual or presumed side effects,
Lack of commitment to a long course of drugs,
Malabsorption,
Social barriers.

Surgery for the treatment of TB

During the early 20th century, surgery played a prominent part in TB management. However after effective TB drugs became available in the mid 20th century the use of surgery declined. Subsequently the emergence of drug resistant TB has led to surgery once again being used as a supplement to drugs for the treatment of TB.

Surgical procedures

Some of the earliest surgical procedures were known collectively as collapse therapies. The aim of these procedures was to deprive the TB bacteria of oxygen.

The use of surgical resection, meaning the removal of part or all of the diseased tissue, in this instance the lung, was used from the 1930s onwards. As techniques were improved surgery became a widely used treatment for TB alongside the development of combination drug treatment. However, as clinical trials increasingly showed that combination treatment for drug susceptible TB was effective, surgery was no longer routinely used in most countries.

Surgery for the treatment of drug resistant TB

In some countries such as Russia surgical interventions, particularly surgical resection, has continued to be used. Also as there has globally been more reports of drug resistant TB, so there have been more reports of the use of surgery. Some lung surgery is also now being carried out in India, following the diagnosis in Mumbai of patients with totally drug resistant TB.5Sumitra, Roy “No cases of deadliest TB strain in Mumbai”, The Times of India, April 17, 2013//articles.timesofindia.indiatimes.com/2013-04-17/mumbai/38615454_1_tb-patients-xxdr-drug-resistant

There is however limited good quality data about the effectiveness of using surgery alongside drug treatment for TB. There is a need for well designed trials to provide more information about the effectiveness of surgery.6“Surgical treatment of drug-resistant tuberculosis” The Lancet Infectious Diseases, February 2012www.thelancet.com/journals/laninf/article/

More about the drugs for TB treatment

More information about individual TB drugs, as well as new TB drugs currently being developed, can be found on the page about TB drugs.

References

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1. “Treatment of Tuberculosis guidelines”, WHO, Geneva, 2011, 29 www.who.int/tb/en/
2. “Treatment of Tuberculosis guidelines”, WHO, Geneva, 2010, 85www.who.int/tb/publications/tb_treatmentguidelines/
3. “The Global Plan to Stop TB”, WHO, Geneva, 2011, vi www.stoptb.org/global/plan/
4. Based on Lambregts-van Weezenbeck, C. S. “Control of drug-resistant tuberculosis” Tubercle and Lung Disease, (1995) 76, 455
5. Sumitra, Roy “No cases of deadliest TB strain in Mumbai”, The Times of India, April 17, 2013//articles.timesofindia.indiatimes.com/2013-04-17/mumbai/38615454_1_tb-patients-xxdr-drug-resistant
6. “Surgical treatment of drug-resistant tuberculosis” The Lancet Infectious Diseases, February 2012www.thelancet.com/journals/laninf/article/