Directly observed therapy tuberculosis

An important problem in the chemotherapy of tuberculosis is bacterial resistance, primarily due to poor patient adherence. To prevent noncompliance and the attendant development of drug-resistant tuberculosis, directly observed therapy is advisable for most patients (i.e., a health care provider observes the patient take the medications 2—5 times weekly). 

Directly observed therapy must be used with twice-weekly dosing For persons who are contacts of patients with isoniazid-resistant, rifampin-susceptible tuberculosis who cannot tolerate pyrazinamide... 

Directly observed therapy (DOT) (where a reliable person supervises each dose). In addition to the areas where it is obviously in the interest of patients that they be supervised, e.g. children, DOT is employed (even imposed) where free-living uncooperative patients may be a menace to the community, e.g. multiple-drug-resistant tuberculosis. 

Reves R, Burman W, Dalton C, et al. A cost-effectiveness analysis of directly-observed therapy versus self-administered therapy for treatment of tuberculosis. Am J RespirCrit Care Med 1997 155(suppl) A33. 

The importance to the continuing study of the molecular mechanism of the /3-lactamases, for the purpose of assessing new /3-lactam structure and for the conceptual development of ideas to preserve the clinical efficacy of the /3-lactams, is certain. Two recent observations underscore this assertion. The basis for /3-lactam resistance by Mycobacterium tuberculosis is the possession of a chromosomally encoded Class A ESBL /3-lactamase, BlaC. This /3-lactamase is, however, inactivated by clavulanate, suggesting the utility of combination /3-lactam-clavulanate therapy for tuberculosis. " A second example involves the site-directed mutagenesis... 

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