viewpoints THE ETERNAL BATTLE WITH DRUG -RESISTANT TUBERCULOSIS Keeping up the pressure with the proper multiple drug regimens is absolutely vital W henever tube rculosis is treated with a single drug, drug resistance develops. So 2-d rug and multiple drug regimens were devised to overcome this. Nevertheless, drug resistan~ across the world va ries widel y from about 2-52%, with ave rages in the US and U K of around 3-796. though it must be recognised that in some areas there may be confu sion between true primary resistance and acquired resistance from previous, undisclosed treatment. Still, the high rates in some parts of the world are disquieting, though patients infected with primary resistant organisms respond well provided that adequate regimens are used. Short course chemotherapy. even with isoniazid /streplOmycin-resislant organisms, may be effective!ro long as the regimen includes streptomycin, isoniazid, rifampicin and pyrazi namide fo r 2 months, followed by rifampici n in the continuation phase. When streptomycin / PAS/ isoniazid·resislance is frequent, the regimen should contain both rifampicin and pyrazinamide but the level o f resistance to these 2 drugs will have to be monitored carefully over the next few years. Adequate regi mens are essential, and it is of concern that in a recent US survey, 2.drug regimens (isoniazid ... ethambutol or rifampicin) were the most used, and only about a third of the programmes used )--d rug regimens. Editorial, British Medical Joornal 281 336 ( I Aug 198 11

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() ADIS Press