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, footnote 2

  • 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, ofloxacin, 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 3 A TB infection of this type is very difficult to treat.

Related Information



  1. Long R, et al. (2007). Drug-resistant tuberculosis. Canadian Tuberculosis Standards, pp. 146–181. Ottawa: Public Health Agency of Canada, Canadian Lung Association. Available online:
  2. American Thoracic Society, Centers for Disease Control and Prevention, Infectious Diseases Society of America (2003). Treatment of tuberculosis. American Journal of Respiratory and Critical Care Medicine, 167(4): 603–662.
  3. Cegielski P, et al. (2012). Challenges and controversies in defining totally drug-resistant tuberculosis. Emerging Infectious Diseases [Internet], November. Available online:


ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care Medicine, Medical Toxicology

Current as ofMay 22, 2015