COMMENTARY - MAKING TUBERCULOSIS TREATMENT AVAILABLE FOR ALL

Tuberculosis is one of the major public health problems that WHO has t ackled throughout the last 50 years. During the pre-clinical era treat ment 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 onl y to the privileged few. The demonstration in the 1960s that ambulator y treatment of tuberculosis (one year of isoniazid and p-aminosalicyli c acid) was as effective for patients and their families as treatment in a sanatorium heralded the beginning of the end of the sanatorium er a and the beginning of the era of domiciliary treatment, which could b e made widely available to many people with the disease in countries w here its prevalence was high. Subsequent refinements in combination th erapy led, in the 1960s, to the development of intermittent regimens a nd, 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.