DOTS has the elements needed for a successful public health program
Can its implementation solve all our problems in TB control?
Limitation of DOTS
High Prevalence Drug-Resistant TB
Drug resistant TB reduces the effectiveness of standard short-course chemotherapy (SCC)
・The situation is worst in areas with high rates of MDR-TB (resistance to isoniazid and rifampin); cure rate of MDR-TB is 30-40% with SCC
・Greatest concern when the level of multidrug resistance among new TB cases is high (primary resistance)
- This means there is substantial transmission in community from MDR-TB cases
- DOTS is necessary but likely not sufficient to control the drug-resistant TB epidemic
