BMJ 1996;313:45-46 (6 July)

Letters

Treatment strategies will need to be changed because of drug resistance

EDITOR,--Dale I Morse notes that the emergence of multidrug resistant Mycobacterium tuberculosis has been one of the spurs to supervised chemotherapy.1 Other aspects of treatment protocols are equally important in controlling the emergence of drug resistance. Currently, the British National Formulary recommends that standard treatment for tuberculosis should be with three drugs (isoniazid, rifampicin, and pyrazinamide). Indications for adding a fourth drug include previous default from treatment and immigration from areas of the world with a high prevalence of drug resistance. The upsurge in tuberculosis in Britain, however, is mainly due to increasing poverty, not immigration.2 Resistance to one or two drugs is not thought to be an important problem in Britain despite experience in other developed countries.3

In this infectious diseases unit we reviewed the sensitivities of 360 sequential positive cultures of M tuberculosis to first line antituberculous treatments (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin). Infected patients had presented . . . [Full text of this article]


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Relevant Article

Directly observed therapy for tuberculosis
Dale I Morse
BMJ 1996 312: 719-720. [Extract] [Full Text]

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