Treatment strategies will need to be changed because of drug resistance

doi:10.1136/bmj.313.7048.45b

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Jon S Friedland,
Gio Simoes

Senior lecturer MSc student Department of Infectious Diseases and Bacteriology, Royal Postgraduate Medical School Hammersmith Hospital, London W12 0NN

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 …