Marcos A Espinal, Christopher Dye
Stop TB Partnership (MAE) and Stop TB Department (CD),
World Health Organization, CH-1211 Geneva, Switzerland
WHO’s strategy for DOTS is the main weapon against the global tuberculosis epidemic. DOTS was originally
an acronym to emphasise directly-observed treatment and short-course chemotherapy with combinations of first-line drugs. It is now better thought of as the brand name of a broader public-health strategy, including diagnosis by sputum-smear microscopy, mechanisms for supporting patients over 6–8 months of treatment, systems for the maintenance of drug supplies, and for recording and reporting. There is abundant evidence that, when all the recommended procedures are in place, chemotherapy under DOTS can achieve cure rates of 90% or more, and prevent the emergence of resistance to first-line drugs. However, it is equally clear that, in populations where resistance has already spread because therapy has been inadequate in the past, first-line drug regimens are associated with higher rates of treatment failure and death.