What is DOTS?

DOTS (directly-observed therapy, short-course) means that the patient taking the medicine should be observed by a nominated person, and the taking of the medicine should be recorded. This ensures that the patient takes the medication regularly, which is essential for the medicines to be effective – and to prevent the bacteria from becoming resistant and the drug from becoming ineffective. The best way to remember to take medicines is to get directly-observed therapy. If following the DOTS regimen, the patient will meet with a health care worker every day or several times a week. This can be at the TB clinic, your home or work, or any other convenient location. You will take your medicines at this place while the health care worker observes. DOTS helps in several ways. The health care worker can help the TB patient remember to take the medicines and complete the treatment. This means he/she will get well as soon as possible. The health care worker will make sure that the medicines are working as they should. This person will also watch for side-effects and answer questions about TB. The TB patient must be checked at different times to make sure everything is going well. He/she should see their doctor or nurse regularly while taking the medicines. This will continue until the patient is cured.

How is TB disease treated?

Tuberculosis is usually treated through the use of a combination of several drugs called antibiotics to kill all the bacteria and preventing them from becoming resistant to one or more drugs. The most common drugs used to fight TB are:
  • isoniazid
  • rifampin
  • pyrazinamide
  • ethambutol
  • streptomycin
The medication is administered to the patient for at least 6 months as per the advice of the doctor. People with TB of the lungs should initially stay home from work or school so that they do not spread TB bacteria to other people. After taking TB drugs for 2 weeks, they will feel better and may not be infectious to others. However, to be completely cured they would need to take the drugs as prescribed for at least 6–8 months.

Why is it important to take TB medicines regularly for the entire duration of the prescribed course?

Sometimes patients stop taking TB medicines on their own before the entire course is completed. However, if the patient does not complete the course of the treatment of TB, it can become harder or impossible to cure the person can stay sick for a longer time the medicines can stop working, and the person may have to take different medicines that have more side effects even the new medicines may not cure the TB TB germs can be passed on to others. TB bacteria die very slowly. It takes at least 6 months to kill all the TB bacteria. People start feeling well after only a few weeks of treatment. But TB bacteria are still alive in the body. That is why it is important to continue to take the medicine until all the TB bacteria are dead, even though the person may feel better and no longer have symptoms of TB disease. If a person with TB disease stops taking his/her prescribed medicines when they feel better, or are not regular in taking the medicines, TB bacteria will grow again. The person will become sick again because the bacteria may become resistant to the drugs he or she was taking. When this happens he/she may need different drugs to kill the TB bacteria if the old drugs no longer work. These new drugs need to be taken for a longer time and usually have more serious side-effects. If a patient on TB treatment becomes infectious again, he/she could spread TB bacteria to their family, friends, or anyone else who spends time with them. It is thus very important to finish the course of medication as per the doctor’s advice. TB patients should talk to their health-care provider if their TB medicine is making them feel sick. Any medicine can cause side-effects, including TB pills. But most people can take their TB medicine without any problems.

What are the side-effects of TB drugs?

Very few people develop side-effects to TB drugs. Minor side-effects include vomiting, nausea, loss of appetite, joint pain, orange/red urine, or skin rash, which can be managed using simple medicines or adjusting the dosages of the drugs. Major side-effects include deafness and dizziness (with the use of streptomycin); jaundice, vomiting (mainly with rifampicin and isoniazid); visual impairment (ethambutol), shock, purpura, or acute renal failure (rifampicin). These side-effects need to be managed by a trained physician and may require hospitalization. It is important to talk to the health-care provider if the medicine is making you feel sick. However, most people can take their TB medicine without any problems.

Once a person completes treatment for TB disease and is cured, can he/she get TB again?

This is unlikely but can, rarely, occur. If the patient has taken the medicine in the right way for as long as the doctor advises, the chances of getting TB again are low. However, if he/she notices any of the signs and symptoms, consult the doctor immediately.

Are there any dietary tips for TB patients?

It is important to eat a balanced diet to provide your body with the nutrients that you need to fight TB. The diet should be simple, easily digestible, and to the liking of the patient to encourage consumption. Meals should be small, but at frequent intervals. Larger meals can be given if the condition of the patient improves. Fluid intake should be sufficient. It is particularly important to avoid drinking any alcohol during the entire course of your treatment as this could result in treatment complications and side-effects. Weight gain generally improves during TB treatment and appropriate nutritional supplementation. It is very important that children with TB get enough energy and nutrients, since children have increased requirements as a result of both growth and TB. TB disease often adversely affects nutritional intake, due to poor appetite, putting patients at risk for malnutrition. Six smaller meals per day are advised instead of three meals. The meals should provide enough energy and protein, and be appetizing in appearance and taste so as to encourage the patient to eat. People with HIV and/or (active) TB need more calories and nutrients in their diet, but they may also have lower appetites and be less able to absorb the nutrients in their food. Force-feeding of the patient to gain extra weight is known to do more harm than good. Too much food – especially fat – frequently causes gastric upsets and diarrhoea. During treatment for TB, eat healthy foods and get enough sleep and some exercise to help your body fight the infection.

Is a person with HIV infection more at risk of developing TB?

Yes. Because HIV infection weakens the immune system, people with TB infection and HIV infection are at very high risk of developing TB disease. All HIV-infected people should be tested for TB. If they have TB disease, they must take TB medicines.

What is drug-resistant TB?

Sometimes the anti-TB drug being taken by the patient can no longer kill the TB bacteria. This is referred to as drug-resistant TB. Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples include: when people do not complete the full course of treatment when health-care providers prescribe the wrong treatment, the wrong dose, or wrong length of time for taking the drugs when the supply of drugs is not always available when the drugs are of poor quality.

Who is at risk of drug-resistant TB?

Drug-resistant TB is more common in people who:
  • do not take their TB drugs regularly
  • do not take all of their TB drugs
  • develop TB disease again, after being treated for TB disease in the past
  • come from areas of the world where drug-resistant TB is common
  • have spent time with someone known to have drug-resistant TB disease.

How is drug-resistant TB spread?

Drug-resistant TB spreads the same way that drugsensitive (i.e. normal) TB is spread. TB is spread  through the air from one person to another, when a person with TB disease of the lungs coughs, sneezes, speaks, spits or sings. These bacteria can remain airborne for several hours, depending on the environment. Persons who breathe in the air containing these TB bacteria can become infected. However, it is NOT spread by:
  • shaking someone’s hand
  • sharing food or drink
  • touching bed linen or toilet seats
  • sharing toothbrushes
  • Kissing