Moving Beyond Directly Observed Therapy for Tuberculosis.

John Z Metcalfe,David R Bangsberg,Max R O’Donnell

doi:10.1371/journal.pmed.1001877

Abstract

Moving Beyond Directly Observed Therapy for Tuberculosis.

Highlights

Mycobacterium tuberculosis often develops resistance in the setting of monotherapy, either de facto or actual (historically, or in the setting of extensively drug resistant tuberculosis (XDR-TB) salvage regimens) [1,2,3,4]
This week in PLOS Medicine, Fielding and colleagues present a cluster randomized trial of an alternative strategy—managing adherence with reminders delivered by an electronic pillbox or text messaging
To what degree does nonadherence lead to treatment failure or acquisition of drug resistance? In contrast to HIV, for which the complex relationship between adherence, pharmacokinetics, and resistance for each antiretroviral class is defined [13], the levels and patterns of adherence that lead to TB treatment failure and drug resistance remain largely unknown [14]

Summary

Introduction

To what degree does nonadherence lead to treatment failure or acquisition of drug resistance? In contrast to HIV, for which the complex relationship between adherence, pharmacokinetics, and resistance for each antiretroviral class is defined [13], the levels and patterns of adherence that lead to TB treatment failure and drug resistance remain largely unknown [14]. This week in PLOS Medicine, Fielding and colleagues present a cluster randomized trial of an alternative strategy—managing adherence with reminders delivered by an electronic pillbox or text messaging.

Results

Conclusion