Directly Observed Therapy- Short course

Before Selman Abraham Waksman discovered Streptomycin- the first antibiotic against Tuberculosis[3]- diagnosis of tuberculosis was literally a death sentence. But even after a while M.tuberculosis became resistant to it. But eventually an effective drug was discovered-INH ( isonicotinylhydrazine) which is a first line drug. Now, we also know that there are resistant strains of Tuberculosis that cannot be treated by any known drugs. This is only because the drugs aren't taken properly. This is already happening and if we are not careful we might again slip back to those days where Tuberculosis name was taken with fear. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better[1]. This makes the Bacterium resistant to it.    

 Directly Observed Therapy- Short course i.e DOTS for short is an effective treatment strategy. It has five components: 

• Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)[3]

• Case detection by sputum smear microscopy[2]

• Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months[2]

• A regular drug supply[2]

• A standardized recording and reporting system that allows assessment of treatment results[2]

In DOTS, there is a health worker or a community volunteer under whom a particular number of patients are assigned. TB patients swallow their medicines under the direct observation of a health worker or community volunteer everyday for the first 2 months of treatment and ideally during the full course of their 6 to 8 months of treatment[1]. This makes sure that the patients take all the medicines regularly and thus it not only ensures that the patients are cured but also ensures that no drug resistant strains are formed. 

In South-East-Asia, every country has adopted DOTS which is THE most cost effective way of fighting Tuberculosis
 

DOTS promises what no other TB control strategy does[1]

• DOTS produces cure rates as high as 95 percent [1]
• DOTS prevents TB bacilli from spreading to others[1]
• DOTS prevents the development of multidrug resistant TB [1]
• DOTS helps countries to reduce medical costs and lost workdays [1]
• DOTS prolongs survival of HIV infected TB  patients [1]
• DOTS more than doubles accuracy of diagnosis of TB [1]

We Already have Cancer, AIDS not to mention new microbes(especially viruses) with newer pathogenic strategies  against which we are yet to find any effective drug. Why to add Tuberculosis to the list when it already had its share of being invincible once upon a time?  

The following shows experiences of patients and Community workers with DOTS

image is taken from [4], pg no 30

image is taken from [4], pg no 30

image is taken from [4], pg no 30

 References:

[1] DOTS the most effective way to stop TB,viewed 25 August 2012,
http://209.61.208.233/LinkFiles/Tuberculosis_right2.pdf

[2]Wikipedia the free encyclopedia n.d., DOTS ,viewed 24 August 2012,
http://en.wikipedia.org/wiki/DOTS

[3]Treatment of Tuberculosis, Antibiotics, Viewed 25 August 2012,
http://www.lung.ca/tb/tbhistory/treatment/antibiotics.html

[4]ICMR BULLETIN, 2003, People with TB:’ DOTS cured me, it will cure you too’, vol 33, no 3,p 30-33 http://icmr.nic.in/bumarch03.pdf