The problem is that many patients often feel better soon after starting a course of treatment and fail to continue with the rest of the medication. Patients may relapse and worse still, drug resistant strains may be selected for and multiply. Only completion of the full course of drugs ensures the elimination of persistent organisms. The problem of compliance is even greater in treatments for multidrug-resistant TB where the course of treatment may require increased numbers of pills to be taken for a period of up to two years. The World Health Organisation has promoted a programme known as DOTS, the Directly Observed Therapy Short Course, in an effort to overcome this problem.
Health workers watch patients swallow each dose to be sure that treatments are completed.
It is relatively expensive, however, to carry out a DOTS programme because of the demands on organisation time and the manpower needed simply to deliver this programme. There is an urgent need for more reliable vaccines against TB and new, effective medicines for the treatment of TB that will help overcome the compliance problem and combat drug resistance. GlaxoSmithKline through its initiative, Action TB, is one of the few companies engaged in a coordinated programme of research to develop novel drugs and vaccines aimed at overcoming and preventing the disease.