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  1. 1

    WHO guidelines for treatment of severe pneumonia [letter]

    Madhi SA; Albrich W

    Lancet. 2007 Aug; 370(9585):386-387.

    The important study by Lisa McNally and colleagues challenges the validity of the WHO recommendations for empirical antibiotic treatment of HIV-infected children with pneumonia. It is, however, important to recognise the limited options for improving these recommendations, given the complexity of the causes of pneumonia among children for whom treatment fails. In particular, changes of antibiotic regimen alone would be unlikely to improve treatment failure in children infected with respiratory viruses (33%). Some of the pneumonias caused by both pneumococci and respiratory viruses might, however, be preventable by vaccination with pneumococcal conjugate vaccines. Additionally, the identification of Pneumocystis jirovecii as the most significant pathogen in infants with treatment failure, despite empirical treatment as recommended by WHO, confirms the limited success of treating HIV-infected children with severe P jirovecii pneumonia. The higher prevalence (15%) of Mycobacterium tuberculosis in this study than in three other studies (8% each), might be related to a greater sensitivity of methods used for sample collection and an increasing burden of tuberculosis. Nevertheless, the observation that M tuberculosis was identified in 21.8% of children with treatment failure perhaps merits most attention. Of particular noteworthiness is that all the studies focused on children with an acute illness, challenging the numerous clinical algorithms used for making a clinical diagnosis of pulmonary tuberculosis and the notion that this disorder rarely presents acutely. The management of childhood pulmonary tuberculosis deserves greater priority and is the one issue that can and should be addressed more urgently. We believe tuberculosis should be included in both diagnostic and therapeutic algorithms for acute childhood pneumonia in areas with high HIV and tuberculosis prevalence. (full text)
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  2. 2

    Global tuberculosis control: surveillance, planning, financing. WHO report 2005.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2005. [255] p. (WHO/HTM/TB/2005.349)

    The goal of this series of annual reports is to chart progress in global TB control and, in particular, to evaluate progress in implementing the DOTS strategy. The first targets set for global TB control were ratified in 1991 by WHO’s World Health Assembly. They are to detect 70% of new smearpositive TB cases, and to successfully treat 85% of these cases. Since these targets were not reached by the end of year 2000 as originally planned, the target year was deferred to 2005.4 In 2000, the United Nations created a new framework for monitoring progress in human development, the MDGs. Among 18 MDG targets, the eighth is to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”. Although the objective is expressed in terms of incidence, the MDGs also specify that progress should be measured in terms of the reduction in TB prevalence and deaths. The target for these two indicators, based on a resolution passed at the 2000 Okinawa (Japan) summit of G8 industrialized nations, and now adopted by the Stop TB Partnership, is to halve TB prevalence and death rates (all forms of TB) between 1990 and 2015. All three measures of impact (incidence, prevalence and death rates) have been added to the two traditional measures of DOTS implementation (case detection and treatment success), so that the MDG framework includes five principal indicators of progress in TB control. All five MDG indicators will, from now on, be evaluated by WHO’s Global TB Surveillance, Planning and Financing Project. The focus is on the performance of NTPs in 22 HBCs, and in priority countries in WHO’s six regions. (excerpt)
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  3. 3
    Peer Reviewed

    Scientific basis of Directly Observed Treatment, Short-course (DOTS).

    Sharma SK; Mohan A

    Journal of the Indian Medical Association. 2003 Mar; 101(3):157.

    The introduction of rifampicin, pyrazinamide and ethambutol ushered in the era of “short course chemotherapy”. Multidrug resistance TB (MDR-TB) is threatening to destabilise the best efforts of TB control. Treatment of MDR-TB is difficult, expensive and toxic and is often unsuccessful. DOTS is an interventional strategy designed to effectively diagnose and treat TB. The fundamental principles in the DOTS strategy are : Polititical will, diagnosis by sputum microscopy, directly observed standardised short-course treatment, adequate supply of good quality drugs, systematic monitoring and accountability. Patients with HIV infection and TB disease respond well to antituberculosis treatment if they are given short-course chemotherapy in the programme of DOTS. (excerpt)
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