Long term efficacy of DOTS regimens for tuberculosis: systematic review.
OBJECTIVE
To identify published studies assessing tuberculosis recurrence after successful treatment with standard short course regimens for six months to determine the strength and sufficiency of evidence to support current guidelines.


METHODS
Systematic review.


METHODS
Medline, Embase, Cochrane clinical trials register, specialist tuberculosis journals, and reference lists. Only English language publications were eligible.


METHODS
Studies were included irrespective of methodology or quality. Abstracted information included inclusion and exclusion criteria for participants, duration of follow-up, and definitions of treatment success and disease recurrence. The primary outcome was the proportion of successfully treated patients recorded with recurrent tuberculosis during the follow-up period.


RESULTS
17 study arms from 16 studies met the inclusion criteria; 10 were controlled clinical trials and six were either studies done under programmatic conditions or observational studies from functioning tuberculosis programmes. Although several clinical trials supported the use of daily treatment regimens, studies reporting tuberculosis recurrence after intermittent regimens were limited. Few studies carried out under routine programmatic conditions reported disease recurrence. Overall there was wide variation in recurrence after successful treatment, ranging from 0% to 14%. Considerable heterogeneity across studies precluded the systematic assessment of factors contributing to tuberculosis recurrence.


CONCLUSIONS
Despite DOTS (directly observed treatment, short course) being implemented for more than 10 years and millions of patients treated for tuberculosis, few studies have assessed the ability of standard DOTS regimens to result in lasting cure for patients treated under routine programmatic conditions.
Cox
Helen S
HS
Australian International Health Institute, University of Melbourne, Carlton, VIC 3010, Melbourne, Australia. hcox@burnet.edu.au
Morrow
Martha
M
Deutschmann
Peter W
PW
D000995:Antitubercular Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D023801:Directly Observed Therapy / Q000592:standards*; D004334:Drug Administration Schedule; D006801:Humans; D017410:Practice Guidelines as Topic; D012008:Recurrence; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents