Smear-negative pulmonary tuberculosis in industrialized countries.

that repeatedly have proven this assumption to be false and a world literature replete with reports of the success of directly observed therapy, these centers contend that there is no firm evidence demonstrating that directly observed therapy is both effective and essential in the treatment of tuberculosis. It is time for physician organizations from all parts of the international community to reject such folly and firmly endorse directly observed therapy as the professional standard of care. And as a corollary standard, as soon as a patient is identified as not adhering to treatment appointments and cannot be induced to cooperate with directly observed therapy (even when provided with a range of social supports), public health officials should immediately direct that patient into a specialized tuberculosis treatment center. If we fully and appropriately treat all patients during their first encounter with tuberculosis, including the use of specialized facilities where necessary, the risk and the fear of MDR tuberculosis can fade into history. The alternative is to stand by and watch as the tidepools described by Iseman slowly enlarge and perhaps return as a flood tide.