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Science 15 March 2002:
Vol. 295. no. 5562, pp. 2042 - 2046
DOI: 10.1126/science.1063814
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Review

Erasing the World's Slow Stain: Strategies to Beat Multidrug-Resistant Tuberculosis

Christopher Dye,* Brian G. Williams, Marcos A. Espinal, Mario C. Raviglione

Multidrug-resistant tuberculosis (MDR) is perceived as a growing hazard to human health worldwide. Judgments about the true scale of the problem, and strategies for containing it, need to come from a balanced appraisal of the epidemiological evidence. We conclude in this review that MDR is, and will probably remain, a locally severe problem; that epidemics can be prevented by fully exploiting the potential of standard short-course chemotherapy (SCC) based on cheap and safe first-line drugs; and that best-practice SCC may even reduce the incidence of MDR where it has already become endemic. On the basis of the available, imperfect data, we recommend a three-part response to the threat of MDR: widespread implementation of SCC as the cornerstone of good tuberculosis control, improved resistance testing and surveillance, and the careful introduction of second-line drugs after a sound evaluation of cost, effectiveness, and feasibility.

Communicable Diseases, World Health Organization, CH-1211 Geneva 27, Switzerland.
*   To whom correspondence should be addressed. E-mail: dyec{at}who.int

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