The medical standard for active TB is a short course treatment involving a combination of isoniazid, rifampicin (also known as Rifampin), pyrazinamide, and ethambutol for the first two months.

[medical citation needed] DOTS stands for "Directly Observed Treatment, Short-course" and is a major plank in the World Health Organization (WHO) Global Plan to Stop TB.

The first element involves creating increased sustainable financial services and a short- and long-term plan provided by the government, dedicated to eliminating tuberculosis.

[medical citation needed] Treatment with properly implemented DOTS has a success rate exceeding 95% and prevents the emergence of further multi-drug resistant strains of tuberculosis.

[medical citation needed] It is possible that shorter durations of therapy (e.g., six months) may be sufficient to treat TB meningitis, but no clinical trial has addressed this issue.

The rules are actually less stringent than many physicians and pharmacists realise: the issue is that the absorption of RMP is reduced if taken with fat, but is unaffected by carbohydrate, protein,[38] or antacids.

A Cochrane review, published in 2016, found moderate quality evidence that "there is probably little or no difference in fixed-dose combination drugs compared to single-drug formulations".

If the patient is so ill that TB treatment cannot be stopped, then STM and EMB should be given until the liver transaminases return to normal (these two drugs are not associated with hepatitis).

[61][12][62][63] The 1994 US CDC guidelines for tuberculosis[64] erroneously cite Slutkin[63] as evidence that a nine-month regimen using only isoniazid and rifampicin is acceptable, but almost all of the patients in that study received ethambutol for the first two to three months (although this is not obvious from the abstract of that article).

If the use of aminoglycosides cannot be avoided (e.g., in treating drug-resistant TB) then serum levels must be closely monitored and the patient warned to report any side-effects (deafness in particular).

The highest rates of drug-resistant TB were in the former USSR, the Baltic states, Argentina, India, and China, and was associated with poor or failing national Tuberculosis Control programmes.

Likewise, the appearance of high rates of MDR-TB in New York city the early 1990s was associated with the dismantling of public health programmes by the Reagan administration.

This is the epidemic for which the acronym XDR-TB was first used, although TB strains that fulfil the current definition have been identified retrospectively,[83][84] this was the largest group of linked cases ever found.

A gene probe for rpoB is available in some countries and this serves as a useful marker for MDR-TB, because isolated RMP resistance is rare (except when patients have a history of being treated with rifampicin alone).

Their efficacy and safety are unknown: There is increasing evidence for the role of surgery (lobectomy or pneumonectomy) in the treatment of MDR-TB, although whether this is should be performed early or late is not yet clearly defined.

The National Tuberculosis Control Program works closely with the primary health care system at the central, provincial, district, and commune levels which has proven to be an incredibly imperative measure of success.

Through its method of search, treat, prevent, and integrative sustainability, FIT is working closely with most of the population on the island (roughly 2022 patients), and partnered with the Ho Chi Minh City Public Health Association on a pilot that provides active community outreach, patient-centric care and stakeholder engagement.

[123] Located in Ha Noi, the National Institute of Tuberculosis and Lung Diseases is responsible for the direction and management of TB control activities at the central level.

TB Alliance also works closely alongside the World Health Organization (WHO), U.S FDA, and the European Medicine Agency (EMA) to endorse regulative policies and treatments that are affordable.

[citation needed] FHI 360 is an international tuberculosis non-profit organization funded by USAID to treat and support patients in Myanmar, China, and Thailand.

[126] This is in part due to severe mismanagement of diagnosis and treatment of TB within the private health care sector of India that serves about 50% of the population.

[126] There are therefore calls for the private sector to engage in the public Revised National Tuberculosis Control Program that has proved effective in reducing TB amongst the patients receiving health care through the government.

[126] Additionally, a study by Maurya et al. conducted in 2013 shows evidence that there is a burden of multidrug-resistant tuberculosis in India and change is needed for testing, surveillance, monitoring, and management.

Although these procedures may be considered barbaric by 21st century's standards, it must be remembered that these treatments represented a potential cure for a disease that at the time had a mortality at least as bad as lung cancer in 2000s.

A patient with MDR-TB who remains culture positive after many months of treatment may be referred for lobectomy or pneumonectomy with the aim of cutting out the infected tissue.

Some complications of treated tuberculosis like recurrent hemoptysis, destroyed or bronchiectasic lungs, and empyema (a collection of pus in the pleural cavity) are also amenable to surgical therapy.

[141] In extrapulmonary TB, surgery is often needed to make a diagnosis (rather than to effect a cure): surgical excision of lymph nodes, drainage of abscesses, tissue biopsy, etc.

[168] The addition of vitamin D appears to enhance the ability of monocytes and macrophages to kill M. tuberculosis in vitro[103][169][170][171][152][172] as well as ameliorating potentially harmful effects of the human immune system.

The evidence suggested that shorter Rifampicin regimes (3 or 4 months) had higher treatment completion rates and fewer adverse events when compared to INH.

[citation needed] Another approach for anti-TB drug development, which does not rely on antibiotics, consists of targeting NAD+ synthase, an essential enzyme in tuberculosis bacteria but not in humans.