Short-course chemotherapy of tuberculosis: the harsh realities

Recent studies have indicated that it is possible to successfully treat even far-advanced tuberculosis with a variety of chemotherapy regimens ranging in duration from 4.5 to 9 months. Furthermore, much or all of some regimens can be given twice-weekly. However, three major barriers remain to widespread success: (1) Noncompliance with prescribed treatment; (2) increasing prevalence of drug resistance; and, (3) sorely limited resources in impoverished segments of the third world. While noncompliance is responsible for a greater number of treatment failures, increasing levels of drug resistance pose a greater long-term threat due to a protracted carrier-vector state, soaring costs for adequate drug regimens, and--ultimately--the conversion of an imminently treatable infection into an unmanageable scourge--the resurrection of the "White Plague."