Preventing Multidrug-Resistant Tuberculosis

Abstract

In the 5 years since the first major outbreaks of multidrug-resistant tuberculosis (MDR TB) in the United States were reported, the epidemiology of MDR TB has become clearer.1,2Clinically, the course of illness can be devastating for both human immunodeficiency virus (HIV)—infected and noninfected persons, especially when diagnosis and adequate therapy are delayed.1,3However, prompt diagnosis and appropriate therapy can improve the likelihood of a successful outcome.4-6Directly observed therapy (DOT) has increasingly become the standard of care7and has been accompanied by dramatic reductions in morbidity and drug resistance, including MDR TB.8,9Evidence supports DOT as the adherence-promoting strategy of choice par excellence. Reflecting an improvement in control efforts is the increase in the proportion of patients completing therapy. In 1993,82% of patients in the United States completed therapy within 12 months, compared with 77% in 1992 (Centers for Disease Control and Prevention [CDC],