The Return of Tuberculosis

Generations of doctors, politicians, and public health officials have struggled to defeat tuberculosis. But, after years of success, TB is making a comeback. The increase in TB in the developed world since 1992 was initially attributed to HIV. However, over time, other factors behind the growing number of cases, such as immigration and a particular type of drug-resistant TB, have emerged.

The World Health Organization has developed a strategy to fight TB’s return, including a standardized therapy that specifies appropriate drugs, doses, and timing of therapy. Unfortunately, multi-drug resistant tuberculosis (MDR-TB), which is any TB resistant to the traditional treatments of isoniazid and rifampicin, represents a serious challenge: because standard treatment is less effective in curing it, its transmission continues.

Moreover, any inadequately treated TB becomes multi-drug resistant, so that treatment failure can be either cause or consequence of MDR-TB. This underscores the need for a determined regimen to treat TB today, as well as a more complex strategy to control the disease, one which cures as many cases as possible, prevents acquired drug resistance and decreases the transmission of infection. The WHO recommends what it calls a “Directly Observed Therapy Strategy” (DOTS) and has set diagnostic thresholds of at least 70% of infectious cases, and curative thresholds of 85%.

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