Treating Multidrug-Resistant Tuberculosis: Compliance and Side Effects

To the Editor. —The recent article by Mahmoudi and Iseman1highlights avoidable pitfalls in the care of patients withMycobacterium tuberculosis. In particular, we would like to underscore their recommendation for greater commitment to TB control programs such as those involving directly observed therapy (DOT). The authors recommend, among other things, that "directly observed therapy should be provided in situations when noncompliance is demonstrated or deemed likely." However, since many studies suggest that predicting a patient's potential for compliance with therapy is itself fraught with difficulties, and since DOT is a proven strategy for TB management,2we recommend implementing DOT more broadly throughout the community. The impact of such a strategy can be demonstrated in the city of Baltimore, Md. Between 1965 and 1978, Baltimore consistently ranked among the first three major US cities in the incidence of TB. In 1978, Baltimore began a clinic-based DOT program for