Tuberculosis 2000: problems and solutions [Unresolved Issues]

The incidence of tuberculosis is expected to increase, from 8.8 million cases in 1995, to 10.2 million cases by the year 2000 and 11.9 million by 2005. Three million deaths due to tuberculosis occurred in 1995, and 3.5 million can be expected in the year 2000.The most important causes of the world-wide increase in tuberculosis are: 1) non-compliance with control programmes; 2) inadequate diagnosis and treatment; 3) migration; 4) endemic human immuno-deficiency virus (HIV); 5) ambulatory and self-administered treatment.In the 1970s it was stated that treatment needed to be supervised-a recommendation that went unheeded. A number of fundamental changes should be introduced in order to make treatment effective, to cure patients and thus to arrest the transmission of the disease: 1) supervision during the whole period antituberculosis drugs are taken, and 2) hospitalization during the initial treatment stage for all groups at risk.It is already 50 years since the first antituberculosis drugs were discovered; effective treatments capable of curing all patients in 6 months have been available for the last 25 years, and the result is failure plus a growing mortality curve at the beginning of the twenty-first century. If we wish to alter this trend, we need trained doctors all over the world who possess enough clinical knowledge of tuberculosis; hospitalization for specific groups of tuberculosis patients; true supervision during the whole treatment period; fixed-dose combinations of drugs; and prophylaxis or preventive treatment whenever possible. We also need to take into account other factors such as drug resistance, endemic HIV, and migration.