Porridge, patience and pills: Why TB treatment takes months to beat
By Willow Health, August 31, 2026Standard TB takes at least six months to treat because its bacteria grow slowly, resist drugs, and can hide dormant in the body – and being around someone with drug-resistant TB means you can catch that same tough strain. It’s the germ that becomes resistant, not the person.
Timpiyian Leseni, a resident of Kajiado County, began experiencing body weakness that kept worsening in 2011. Her several visits to local hospitals did not unravel the cause of her illness.
“It took a month of hospital visits before I got the correct diagnosis. The doctor told me that I had contracted zoonotic tuberculosis, something I didn’t know existed,” she told Willow Health Media. Doctors explained that this type of TB is transmissible through infected animal products like unpasteurised milk, blood or undercooked meat.
Timpiyian was relieved to finally know the cause of her illness, but the news that she would need at least six months of medication drained her strength as “My experience taking TB drugs was not easy. The tablets are large and difficult to swallow,” she explained. “Many times they wouldn’t go down the throat easily, making me vomit.”
One nurse advised her to swallow the tablets with porridge instead of water, a method that worked well for her. “It also took the moral support from my family to adhere to the treatment. Nutritional support is vital for TB patients on medication; the drugs must never be taken on an empty stomach,” she added.
With her family’s support, Timpiyian stayed on her medication for seven months, an adherence many patients do not manage because of the stigma attached to TB treatment. “Many patients with pulmonary TB take drugs for six months. I had zoonotic and abdominal TB and had to take my medication for seven months to be fully cured,” she said.
TB Treatment plans
TB can be pulmonary (affecting lungs) or extrapulmonary (affecting brain, stomach, spine), and each have different treatment plans
Her experience reflects a wider pattern rooted in the biology of the disease itself. Evaline Kibuchi, a global TB advocate, explained that tuberculosis treatment takes longer because the bacteria that cause it, Mycobacterium Tuberculosis, are difficult to kill. “There are bacteria that are completely eliminated using antimicrobials for three days; others take five days, a week or 10 days. The TB-causing bacteria, however, are difficult to eliminate because they grow slowly and have tough walls that are not easy for antibiotics to penetrate,” she said. Long-term antibiotic use is needed, she added, because the bacteria can hide dormant in the body’s immune cells before waking up later.
Prof Lameck Diero, a TB and respiratory health expert at the Academic Model Providing Access to Healthcare (AMPATH), explained that TB can be pulmonary (affecting the lungs) or extrapulmonary (affecting other body parts such as the brain, stomach and spine), with each type following a different treatment plan. The shortest treatment duration, for standard drug-susceptible TB, is six months.
“For extrapulmonary TB, patients use four drugs in the first intensive four months, while in pulmonary TB the intensive treatment period is two months,” he said. During this intensive phase, patients on either type receive Rifampicin, Isoniazid, Pyrazinamide and Ethambutol. For standard drug-susceptible TB, the continuation phase that follows uses Rifampicin and Isoniazid for four months; some retreatment cases add a third drug, Ethambutol.
For extrapulmonary TB, the continuation phase can run to four months or more. “The continuation phase eradicates dormant or persistent bacteria left after the intensive phase, prevents relapse, and lowers the chance for bacteria to adapt and become drug-resistant,” Prof Diero said adding that the bacteria’s tough, thick, waxy outer shell makes it hard for drugs to penetrate, and that long therapy ensures the drug is present to destroy dormant bacteria whenever they reactivate or emerge from the walled clusters, known as granuloma tissue, where they hide.
Kibuchi also explained that TB bacteria are stubborn, and without sustained antibiotic pressure, they can develop into Drug Resistant (DR) strains. “DR TB is like a country which was attacked but not neutralised during a war, only to come back into the fight with sophisticated weapons. It therefore requires stronger armour (medication) to be defeated; that’s why treating it takes up to a year or more,” she said. Patients who default on treatment are the ones most likely to develop DR-TB or Multi-Drug Resistant TB (MDR-TB). “Individuals close to someone with drug-resistant TB will likely get infected with drug-resistant TB. It’s the bacteria that mutates and gets resistant, not the patient,” she added.
Treatment for MDR-TB has itself become faster. According to the National Tuberculosis, Leprosy and Lung Disease Program (NLTP), Kenya adopted the BPaL (Bedaquiline, Pretomanid and Linezolid) protocol in June 2024, cutting MDR-TB treatment to six months, down from the 24 months the older regimen required.
Patients must take their prescribed TB drugs daily at the exact time for treatment to work
Prof Diero stressed that patients must take their prescribed TB drugs daily at the exact time for the treatment to work. Timpiyian agreed that failing to adhere makes TB more dangerous. “Abandoning drugs may lead to drug resistance, including multi-drug resistant TB. TB is not like pneumonia, whose treatment may take only a few days. It takes a longer treatment period to fully clear the bacteria from the body,” she said.
Kibuchi linked many defaulting cases to a lack of proper, sustained information about TB treatment compared with other diseases such as malaria. Kenya’s TB drug default rate, also called “Loss to Follow-Up” (LTFU), ranges between 4 and 5.4 per cent nationally, according to the NLTP, though some regions record rates of between 13 and 35 per cent. Most defaults, 43.1 per cent, occur during the intensive two-month treatment window: 22.7 per cent in the first month and 20.4 per cent in the second. A study by the Liverpool University of Tropical Medicine in western Kenya found that 42.4 per cent of LTFU cases involved patients who tested positive but failed to start treatment within 14 days of diagnosis.
Kibuchi called for more public information on measures such as opening public vehicle windows to cut transmission, proper diet to support treatment, and disclosure by patients to protect those around them. Better counselling, made possible by a personal connection between healthcare workers and patients, would improve adherence, she said, adding: “Unfortunately, most healthcare workers are already overwhelmed dealing with numerous other cases, hence cannot pay more attention to those taking drugs.”
Stigma remains a bottleneck. “We’ve made TB look like a disease for the poor in slums. People in higher economic class zones should openly share experiences and talk about TB to encourage more people to go for timely tests and initiate treatment,” Kibuchi said. She also called for more public understanding of TB/HIV coinfection to counter stigma, noting that coinfection rates have fallen from between 39 and 50 per cent a decade ago to 23 per cent today, thanks to greater access to antiretrovirals. “Though HIV lowers immunity, having TB doesn’t always mean one is HIV positive,” she added.
Timpiyian re-emphasised the need for dietary support for patients on medication, saying its absence contributes to people defaulting on treatment.
Despite the diagnosis gaps, stigma, adherence hurdles and dietary shortcomings, Kibuchi believes TB can be beaten in Kenya. “TB is curable once detected early and patients adhere to medication,” she said. Her message to stakeholders: “Patients need healthcare workers and family support to get a proper diet. Those diagnosed have the responsibility to inform people close to them about their TB diagnosis and urge them to screen and reduce transmission risk.”
She revealed that a shorter TB treatment regimen is in the pipeline, to be rolled out first to priority populations before wider adoption. Kenya has already adopted two WHO-recommended TB Prevention Treatment (TPT) regimens, introduced in January and April 2026: a six-month daily levofloxacin course for contacts of MDR-TB patients, and a three-month weekly combination of isoniazid and rifapentine (3HP) for children aged 0–14.