BMJ 1999;318:736 ( 13 March )

Letters

Control of multidrug resistant tuberculosis

DOTS-plus strategy will be hard to implement

The first 150 words of the full text of this article appear below.

EDITOR---Farmer and Kim propose a "DOTS-plus" strategy to attempt controlling multidrug resistant tuberculosis.1 As much as I sympathise with them, after following several patients with multidrug resistant tuberculosis and watching them die, I am concerned and sceptical about such a strategy being implemented in low income areas.

The development of multidrug resistant tuberculosis is a complex multifactorial process, and wide distribution of new drugs will not solve the problem. Need to generate an income, family duties, religious misconceptions, social stigma, and mismanagement by health practitioners constitute only a limited list of some of the obstacles that patients must face before successful treatment. Drugs used to treat multidrug resistant tuberculosis are not very effective, often have undesirable side effects, and must be given for prolonged periods. Who will supervise such complex regimens? Who will observe the prescribers? Directly observed therapy (DOT) requires directly observed doctors,2 but DOTS-plus will make . . . [Full text of this article]
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Relevant Article

Community based approaches to the control of multidrug resistant tuberculosis: introducing "DOTS-plus"
Paul Farmer and Jim Yong Kim
BMJ 1998 317: 671-674. [Extract] [Full Text] [PDF]

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