Intermittent and directly observed chemotherapy: The sensible therapeutic option in the treatment of tuberculosis

Intermittent chemotherapy for tuberculosis-treatment given two or three times each week-is as effective as treatment given every day. Specifically, treatment given three times each week (without a phase of daily therapy) is as effective as treatment given daily. If treatment is given twice weekly, cure rates are equivalent to those achieved when a daily phase is given, and recent evidence suggests that a daily phase is not necessary. Directly observed therapy has been shown to be a highly effective strategy in resource-poor settings and by achieving high completion rates. In combination, directly observed, and intermittent therapy is shown to be highly cost-effective. In the HIV era, with a much increased tuberculosis case-load, hospitalization for 2 months to ensure adherence may no longer be possible. Intermittent and directly observed chemotherapy is indeed the sensible therapeutic option in the treatment of tuberculosis, especially when treatment is delivered in the community in resource-poor settings.