Realistic Chemotherapeutic Policies for Tuberculosis in the Developing Countries

Abstract

Many developing countries are desperately short of funds for their health services and have major shortages of all cadres of medical, nursing and technical staff. Physicians treating tuberculosis in developing countries must be highly selective in their choice and application of facilities which exist in technically advanced countries. The cost of antituberculosis medicaments is a very important consideration in developing countries. The main priority of chemotherapy is to give every newly diagnosed case of active tuberculosis a year of uninterrupted chemotherapy with the best regimen which the budgetary permits. The regimen will change as resources improve. It is necessary to educate the authorities and general public concerning the importance of adequate chemotherapy for tuberculosis. Subsidiary targets of chemotherapy are (a) to have drugs for reserve regimens; (b) to give a second year of chemotherapy for quiescent cases—namely isoniazid alone if there is no residual cavitation at one year and combined chemotherapy if there is ; and (c) chemoprophylaxis of high-risk groups. During treatment bacteriological examinations are more informative than radiography, and progress can adequately be assessed by smear examinations, which are very cheap. Initially, cultures should be reserved for diagnostic purposes and sensitivity tests for the measurement of the prevalence of drug resistance in the community. A consideration of the results of controlled comparisons of sanatorium and clinic treatment, of rest in bed and ambulation in sanatorium, of the relapse rates in patients, and of the risk to contacts, as well as the economics of sanatorium and clinic construction and treatment, leads to the conclusion that developing countries should concentrate on ambulatory domiciliary chemotherapy. Expenditure on tuberculosis must be related to the overall health priorities of the community. © 1964, British Medical Journal Publishing Group. All rights reserved.