Commentary: making tuberculosis treatment available for all

Tuberculosis is one of the major public health problems that WHO has tackled throughout the last 50 years. During the pre-clinical era treatment consisted of the use of special diets, bed rest in sanatoria, and lung collapse therapy. The case fatality rate 5 years after diagnosis was 50% and treatment in a sanatorium was expensive and available only to the privileged few. The demonstration in the 1960s that ambulatory treatment of tuberculosis (one year of isoniazid and p-aminosalicylic acid) was as effective for patients and their families as treatment in a sanatorium heralded the beginning of the end of the sanatorium era and the beginning of the era of domiciliary treatment, which could be made widely available to many people with the disease in countries where its prevalence was high. Subsequent refinements in combination therapy led, in the 1960s, to the development of intermittent regimens and, in the 1970s, to short-course regimens following the introduction of rifampicin. The currently recommended WHO strategy for tuberculosis control is termed DOTS, which is being promoted globally to free the world from this millennia-old scourge.