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Community based approaches to the control of multidrug resistant tuberculosis: introducing “DOTS-plus”
Open accessAbstract
Tuberculosis remains the world's leading infectious cause of adult deaths, most of which are due not to multidrug resistant tuberculosis but to lack of access to effective treatment for drug susceptible tuberculous disease.1 New data suggest, however, that multidrug resistant tuberculosis is emerging as an increasingly important cause of morbidity and death. In the United States, Europe, and Latin America, highly resistant strains of tuberculosis have caused explosive institutional outbreaks (in hospitals, prisons, and homeless shelters) with high case fatality rates among immunosuppressed people and high rates of transmission to other patients and to caregivers and their families.2–8 These outbreaks are not restricted to certain regions. The WHO/International Union Against Tuberculosis and Lung Disease's global survey of resistance to antituberculous drugs now reveals that multidrug resistant tuberculosis has already become established worldwide. In several countries—including Russia, Estonia, Latvia, Cote d'Ivoire, and the Dominican Republic—“hot zones” of ongoing transmission have been identified. Failure to follow the World Health Organisation's guidelines was clearly associated with high rates of multidrug resistant tuberculosis; the survey was thus able to identify countries in which an increase in multidrug resistant tuberculosis was likely, given the current programme conditions.9 #### Summary points Multidrug resistant tuberculosis is already a global pandemic, with focal “hot zones” of increased transmission Although DOTS (directly observed treatment, short course) chemotherapy is the goal of global tuberculosis control, short course chemotherapy will not cure multidrug resistant tuberculosis In settings of high transmission of multidrug resistant tuberculosis, “DOTS-plus” (a complementary DOTS based strategy with provisions for treating multidrug resistant tuberculosis) is warranted Community based strategies designed to enhance local capacity are cost effective and make it possible to meet new medical challenges Unfortunately, treatment options have been limited for most people with multidrug resistant tuberculosis, largely because of the cost of drugs. …
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Several studies have shown that MDR TB can be cured by a combination of second-line drugs under DOTS-Plus.
“Several studies have shown that MDR TB can be cured by a combination of second-line drugs under DOTS-Plus, the treatment strategy proposed by the World Health Organization to address the management of MDR TB in settings with good control programs (15, 18, 22, 30, 35, 48).”
From Resazurin Microtiter Assay Plate Testing of Mycobacterium tuberculosis Susceptibilities to Second-Line Drugs: Rapid, Simple, and Inexpensive Method (2003) · cites this paper as [18]
The paper says that a review of several studies links effective treatment with longer courses of second-line drugs to falling MDR-TB incidence (p. 671), and it describes DOTS-plus as a strategy most likely to succeed where DOTS is established or being established (p. 672). It also says available drugs can cure most patients, but its reported Peru outcomes are negative smears and cultures one year into treatment—not several studies demonstrating cure under DOTS-plus. (LLM, conf=0.84)
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Research works printed but not linked: 21
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- Farmer PE, Bayona J, Becerra M, Shin S, Nuñez C, Nardell E, International Working Group on Multidrug-Resistant Tuberculosis .The emergence of MDRTB in urban Peru: a population-based study usingc onventional, molecular, and ethnographic methods.Conference on Global Lung Health and the 1997 Annual Meeting of the International Union Against Tuberculosis and Lung Disease,Paris,October 1-4, 1997. (Posterp resentation.)
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Infectious Diseases, Non–Zero-Sum Thinking, and the Developing World
Folch, E., Hernandez, I., Barragan, M., & Franco-Paredes, C. (2003) · The American Journal of the Medical Sciences · doi:10.1097/00000441-200308000-00003 · Cited by 39
Metadata
- Authors
- Farmer, P., & Kim, J. Y.
- Affiliations
- Harvard University (US)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1998-09-05
- Volume
- 317
- Issue
- 7159
- Pages
- 671-674
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1113843
- OpenAlex
- W1991591189
- Cited by
- 256
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2020: 7 · 2019: 5 · 2018: 6 · 2017: 9 · 2016: 6 · 2015: 1 · 2014: 4 · 2013: 5 · 2012: 8
- FWCI
- 10.34
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › HIV, TB, and STIs Epidemiology
- Keywords
- multidrug-resistant tuberculosis, DOTS-Plus, directly observed therapy, tuberculosis transmission, institutional outbreaks, drug-resistant tuberculosis, WHO guidelines, treatment access, drug costs
- MeSH terms
- Cost-Benefit Analysis, Humans, Global Health, Incidence, Tuberculosis, Multidrug-Resistant
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