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Editorial
May 17, 2000

The Global Problem of Multidrug-Resistant TuberculosisThe Genie Is out of the Bottle

Author Affiliations

Author Affiliation: Schools of Public Health and Medicine, Boston University, Boston, Mass.

JAMA. 2000;283(19):2575-2576. doi:10.1001/jama.283.19.2575

Drug-resistant tuberculosis (TB) was first observed in 1948, subsequent to the first trials of streptomycin for TB treatment.1 Ever since then, drug-resistant TB has been recognized to occur as the result of suboptimal TB treatment. In a recent survey of 35 countries, 12.6% of Mycobacterium tuberculosis isolates were resistant to at least 1 drug, and 2.2% were resistant to both of the primary drugs used to treat TB, isoniazid and rifampin.2 Thus, today most cases of TB are drug susceptible at the time of diagnosis, only becoming drug resistant through suboptimal therapy. Therefore, the World Health Organization has focused its efforts to combat multidrug-resistant TB on a strategy of preventing the generation of new multidrug-resistant TB cases. This program, directly observed therapy short-course (DOTS), relies on local government commitment to a sustained effort using case detection by sputum microscopy, directly observed treatment with a standard therapeutic regimen, maintenance of an uninterrupted drug supply, and monitoring outcome with a standard reporting system.

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