BMJ  2003;327:164 (19 July), doi:10.1136/bmj.327.7407.164

Letter

Impact of DOTS and DOTS-plus on multidrug resistant TB

DOTS-plus strengthens, not weakens, DOTS programmes

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

EDITOR—In their decision analysis Sterling et al hypothesise but offer no evidence that the efficacy of DOTS (directly observed treatment, short course) has ever been diminished by DOTS-plus.¹ On the contrary, under the current rigorous procedure for obtaining second line drugs at drastically reduced prices, the Green Light Committee of the World Health Organization assures that only programmes with demonstrably strong DOTS and DOTS-plus components are approved, and then only under the continuous, close supervision of the committee.²

Sterling et al used a 47% cure rate for multidrug resistant tuberculosis under DOTS, but the US Centers for Disease Control and Prevention reported cure rates as low as 5% in Russia.³ Moreover, Migliori et al acknowledged a 25% rate of late failures among patients with chronic multidrug resistant tuberculosis in Russia who were smear negative (and thus considered cured) at the end of treatment, indicating that the true cure . . . [Full text of this article]

Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA enardell@pih.org

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Impact of DOTS compared with DOTS-plus on multidrug resistant tuberculosis and tuberculosis deaths: decision analysis

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