Short-course instead of long-course chemotherapy for smear-negative patients in sub-Saharan Africa

The use of short-course chemotherapy (SCC) in directly-observed treatment, short-course (DOTS) programmes in sub-Saharan Africa was often restricted t o patients with infectious and serious forms of tuberculosis, because of hi gh costs of such regimens. With reduced drug prices and wide-scale substitu tion of thiacetazone by ethambutol in the continuation phase of treatment, various short-course regimens are now available at the same or even lower c osts than long-course regimens. Several DOTS programmes ace considering ext ending access to short-course chemotherapy to non-infectious patients, or h ave done so already. The authors provide an overview of the issues regardin g the debate on the introduction of universal SCC in national tuberculosis control programmes in low-income countries in sub-Saharan Africa. They advi se on a low-risk strategy to avoid the emergence of rifampicin resistance a s a consequence of the wide availability of rifampicin associated with univ ersal short-course, and strengthening of the health system to maintain high performance levels in diagnosis and treatment.