Containing Tuberculosis

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Science  07 Jul 2000:
Vol. 289, Issue 5476, pp. 15
DOI: 10.1126/science.289.5476.15a

Mycobacterium tuberculosis kills more than 2 million people each year, and the emergence of multiple drug-resistant strains (MDR-TB) is of worldwide concern. Dye and Williams combine modeling with data analysis to develop containment scenarios for the current threat from MDR-TB.

Although there is some evidence that drug-resistant bacilli are less infectious, the authors take a conservative approach in developing their models; their results suggest that employing best practice chemotherapy and four inexpensive first-line drugs for 6 to 8 months of treatment can prevent the emergence of MDR-TB. To ensure a favorable outcome, first-line treatment regimes must achieve cure rates of more than 80%, in conjunction with rapid case detection. It remains easier to prevent MDR-TB from arising than to control an established epidemic, as interruption of MDR-TB transmission would require that 70% of these cases be detected each year and that 80% of these be cured. Nevertheless, there still is no escape from the realization that effective containment of MDR-TB requires new, affordable, and effective second-line drugs. — CA

Proc. Natl. Acad. Sci. U.S.A., in press.

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