DOTS (directly observed treatment, short-course), is the name given to the tuberculosis control strategy

recommended by the World Health Organization.[1] According to WHO, The most cost-effective way to
stop the spread of TB in communities with a high incidence is by curing it. The best curative method for
TB is known as DOTS.[2] DOTS has five main components:

Government commitment (including political will at all levels, and establishment of a centralized
and prioritized system of TB monitoring, recording and training).

Case detection by sputum smear microscopy.

Standardized treatment regimen directly of six to eight months observed by a healthcare worker
or community health worker for at least the first two months.

A drug supply.

A standardized recording and reporting system that allows assessment of treatment results.

Tuberculosis can affect many areas of the body, but it most commonly causes disease in the lungs. The
American Thoracic Society, in conjunction with the Centers for Disease Control and Prevention and the
Infectious Disease Society of America, has formulated a classification system for TB to help guide
treatment of the disease and provide an operational framework for public health agencies. This system
uses 6 categories of pulmonary TB -- 0 through 5. Class 0 indicates individuals who are not infected.
People in this group have had no exposure to TB, and their tuberculin skin test results, if done, are
negative.
Exposure but No Evidence of Infection People in class 1 have been exposed to TB, but their
subsequent tuberculin skin test results are negative. The follow-up course of action for people in this
category depends on several factors, including how recent and extensive the exposure was and the
overall health of the individual. Significant exposure within the past 3 months warrants a follow-up skin
test at about 10 weeks after exposure. Sometimes, treatment is started while waiting for the skin test
results, particularly in individuals with HIV or young children.
Latent Infection but No Disease Class 2 identifies those people who have a positive reaction to the
tuberculin skin test but no symptoms or other evidence of TB on a chest x-ray or additional testing.
People in this category do not feel sick and cannot spread the disease at this stage, but if left untreated,
latent TB has the potential to develop into active disease, or class 3 TB. Recommended treatment varies
depending on a number of factors. For example, people with HIV and infants and children less than 5
have an increased risk of developing class 3 TB, so they may warrant additional or longer treatment
regimens.
Active Tuberculosis Class 3 includes anyone with active TB based on the presence of symptoms or
positive laboratory testing. Typical symptoms include a persistent cough that may produce blood or
mucus, fever, chills, night sweats, pain in the chest, loss of appetite, weight loss and weakness. A
diagnosis of active TB can be confirmed via a number of lab tests, the most important of which is
identifying the presence of Mycobacterium tuberculosis -- the bacteria that causes TB -- in the body. The
most common way to diagnose active pulmonary TB is by finding the bacteria in a sample of sputum.
Inactive or Suspected Tuberculosis Class 4 TB identifies people who had active TB in the past but no
longer show any evidence of active disease. Their skin tests are positive and chest x-rays may be
abnormal, but they have no symptoms and their lab tests are negative. Class 5 includes those individuals
who are suspected of having TB but are still waiting for test results to confirm whether they have the
disease. Some people in class 5 may already be receiving treatment while they wait for the final test
results. Once all test results are completed, the individual will be moved to the most appropriate class.

TB drugs the basic drugs The five basic or first line TB drugs are:2 Isoniazid Rifampicin Pyrazinamide
Ethambutol and Streptomycin These are the TB drugs that generally have the greatest activity against TB
bacteria and they are core to any TB drug treatment program. These TB drugs are particularly used for
someone with active TB disease who has not had TB drug treatment before.

All the other TB drugs are generally referred to as second line or reserve TB drugs.

TB drug treatment for new patients New patients are those who have either not had any TB treatment
before, or they have only had less than one month of anti TB drugs. New patients are presumed to have
drug susceptible TB (i.e. TB which is not resistant to any of the drugs) unless there is a high level of
isoniazid resistance in new patients in the area, or the patient has developed active TB disease after they
have had contact with a patient who is known to have drug resistant TB.
For these patients the World Health Organisation (WHO) recommends that they should have six months
of TB drug treatment. This should consist of a two month intensive treatment phase followed by a four
month continuation phase.
For the two month intensive TB drug treatment phase they should receive:
Isoniazid with rifampicin and pyrazinamide and ethambutol followed by
Isoniazid with rifampicin for the continuation TB drug treatment phase.
It is essential to take several TB drugs together. If only one TB drug is taken on its own, then the patient
will very quickly become resistant to that drug.
It is recommended that patients take the TB drugs every day for the six months, although taking them
three times a week is possible in some circumstances. It is extremely important that all the recommended
TB drugs are taken for the entire time.
If only one or two of the TB drugs are taken, or the treatment is interrupted or stopped early, then the
treatment probably wont work, because the TB bacteria that a patient has develops resistance to the TB
drugs. Not only is the patient then still ill, but to be cured they then have to take drugs for the treatment of
drug resistant TB, and these drugs are more expensive and have more side effects.

TB drugs for the treatment of drug resistant TB For the treatment of drug resistant TB, the current TB
drugs are grouped according their effectiveness, experience of use, and drug class, as shown below.
All the first line TB drugs are in Group or class 1, apart from streptomycin which is with the other
injectable agents in Group 2. All the drugs in Groups 2 to 5, apart from streptomycin, are referred to as
second line or reserve TB drugs.3 The first four groups of TB drugs listed below, are those that are
mainly used for the treatment of drug resistant TB. The fifth group of TB drugs are some drugs that are
unknown in how effective they are in the treatment of TB, but they can be tried when there is no other
option, such as in the treatment of totally drug resistant TB.

TB drugs used to treat drug resistant TB according to group (class)

Group 1 TB drugs : First Line Oral Agents
pyrazinamide
ethambutol
rifabutin
Group 2 TB drugs : Injectable Agents
kanamycin
amikacin
capreomycin
streptomycin
Group 3 TB drugs : Fluoroquinolones
levofloxacin
moxifloxacin
ofloxacin
Group 4 TB drugs : Oral Bacteriostatic Second Line Agents
paraaminosalicylic acid
cycloserine
terizidone
thionamide
protionamide
Group 5 TB drugs: Agents with an unclear role in the treatment of drug resistant TB
clofazimine
linezolid
amoxicillin/clavulanate
thioacetazone
imipenem/cilastatin
high dose isoniazid

clarithromycin
Very few actual trials have been carried out of the drugs in Group 5 to see how effective they actually are
in the treatment of drug resistant TB. For example, the drug linezolid is an antibiotic usually used to treat
severe bacterial infections. The first trial has just been carried out of this drug looking at the use of it in
treating XDR-TB. It was a small trial but it did show that the drug was effective when added to patients
current treatments, although most of the patients experienced side effects.4