© 2006 American Thoracic Society
Failure to Mention Fixed-Dose Drug Combinations in the ATS/CDC/IDSA Tuberculosis Control StatementFrom the Authors:We are pleased to respond to Dr. Moulding's letter, because it gives us the opportunity to emphasize an important point about the new American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America (ATS/CDC/IDSA) statement (1). This statement, comprehensive as it is, does not stand alone in providing recommendations for diagnosis, treatment, prevention, and control of tuberculosis (TB) in the United States. Rather, the statement is one of a series that are issued periodically by the sponsoring organizations (1–4) to guide the spectrum of activities associated with the management and control of TB. This statement makes recommendations for organizing the process of TB control in the United States, including a description of the essential activities and the roles and responsibilities of the range of participants. It was not designed to reiterate recommendations on standards of diagnosis and treatment of TB and latent infection, which are covered in detail in the other current statements (2–4). As noted by Dr. Moulding, the statement on treatment of TB (2) makes explicit recommendations on practical therapeutic approaches to individual patients managed with directly observed and self-supervised therapy. Directly observed therapy (DOT) needed to be discussed in some detail in our statement because, to quote from the treatment statement, DOT is "the central element in a comprehensive, patient-centered approach to case management" (2) and as such is an essential component of the public health infrastructure for TB control in the United States today. It is important to emphasize that TB treatment benefits not only the patient with the disease but also the community, and that every medical practitioner who undertakes such treatment assumes the responsibility to not only prescribe an appropriate regimen but also to assure adherence until treatment is completed (2). Collaborative arrangements between practitioners and public health agencies are recommended by both recent ATS/CDC/IDSA statements (1, 2) to achieve this goal of therapy. These practical issues of TB treatment, such as DOT, case management, and the use of fixed-dose drug combinations, derive their importance from their role in enhancing the likelihood that patients with TB complete the lengthy course of therapy that is necessary to cure the disease and avoid treatment failure, relapse, and the acquisition of drug resistance. New drug regimens that could reduce the length of treatment for TB would potentially lessen the administrative burden and intensity of resources needed for DOT and individualized case management. Work on new TB drugs has been intensifying (5), and there is reason for optimism that the length of standardized therapy for TB can be further reduced (6).
Co-Chairs of the Ad Hoc Committee of the American Thoracic Society, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America FOOTNOTES Conflict of Interest Statement: None of the authors have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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