EDITORIALS
The evidence based treatment of tuberculosis: where and why are we failing?
Correspondence to:
Professor Lawrence L Peter Ormerod, Royal Blackburn Hospital, Lancs BB2 3HH, UK; Lawrence.Ormerod@elht.nhs.uk
| The first 150 words of the full text of this article appear below. |
THE SCALE OF THE PROBLEM
Tuberculosis is increasing both globally and nationally, so its management is becoming even more important. Globally, it is estimated that there are at least 7.96 million (95% confidence interval 6.3–11.1) clinical cases, with 3.52 million (2.8–4.1) sputum microscopy positive cases, and 1.87 million (1.4–2.8) deaths.1 This gives a case fatality rate of 23%. In addition, 32% of the world’s population (1.86 billion) are infected, as judged by a positive tuberculin skin test.1 In England and Wales after a nadir of 5000 cases per year, numbers have reached over 8000.2
THE SCIENTIFIC BASIS FOR SHORT COURSE CHEMOTHERAPY
Each of the antituberculosis drugs vary in their abilities to kill organisms, to sterilise lesions and to prevent the emergence of drug resistance.3 Isoniazid is the best drug for killing rapidly dividing organisms, followed by rifampicin and then streptomycin and ethambutol. Rifampicin is best for dormant organisms with occasional spurts of metabolism, and pyrazinamide is best for organisms in an intracellular
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