Highly Drug-Resistant Tuberculosis-Reply

Abstract

In Reply. —As Dr Ponce de Leon and colleagues note, the epidemiology of drug-resistant TB must be evaluated locally. Drug resistance is the result of improper treatment—incorrect regimens and insufficient emphasis on ensuring treatment completion by direct observation. If antituberculosis drugs are introduced without adequate treatment programs, acquired drug resistance increases. After acquired drug resistance increases, primary drug resistance will increase with the pace of the increase greatly accelerated in populations where HIV is common. Effective treatment programs decrease the incidence of drug-resistant tuberculosis. 1,2 Referral centers tend to attract patients with acquired drug resistance, and, hence, drug resistance and molecular epidemiologic investigations of patients treated at such centers, as Ponce de Leon and colleagues note, are not representative. Findings about specific DNA patterns cannot be generalized from our report. What can be learned is that, in the absence of an effective tuberculosis control program and the presence of HIV, multidrug-resistant TB