Further studies are needed to resolve whether the remarkable public health gains
achieved under the WHO's anti-tuberculosis programme are at risk, say G. E.
Davies and S. B. Squire in this British Medical Journal
Davies says that a review of the international organisation's DOTS (directly observed therapy short course) programme — which comes 15 years after the introduction of DOTS — has found worrying differences in relapse rates after treatment, the most important measure of treatment efficacy in clinical trials.
Doubts have been raised about the effectiveness of direct observation strategies as opposed to self-administration. "If neither the direct observation nor the short course components of the strategy is as evidence-based as we thought, where does this leave the scientific credibility of DOTS?" ask the authors.
A better understanding of the associations between the bacterial markers used to monitor treatment and the pharmacodynamic processes that underly them, along with more extensive molecular epidemiological studies, would help clarify the findings of the review.