Dr. Raviglione said he did not know how much more the strategy would cost, because his group was just starting to study the problem. In interviews, several experts said the WHO recommendations were highly likely to intensify an already emotional debate on expanding the recommended treatment for some patients at a time when two million people a year die worldwide for lack of adequate care. At a meeting last month in Madrid, opponents of the expanded strategy argued that emphasizing the treatment would shift desperately needed resources away from patients with tuberculosis that was not drug resistant. But six years later, fewer than 20 percent of patients get even basic treatment. Dr. Frieden said efforts to combat multiple-resistant TB should focus on its cause, inadequate treatment of ordinary tuberculosis.
Tuberculosis is known to acquire resistance to drugs that are given to patients inefficiently.
If the wrong drugs or doses are given for too short a time or if the patients stop taking them, the bacteria that survive may become drug resistant. Dr. Frieden and other experts fear that if new more effective drugs are also given badly, the multiresistant strains will eventually become unresponsive to those drugs too, making a bad situation worse. But he said inadequate treatment was no longer the sole cause of such strains. He said multiresistant tuberculosis now threatened not just poorer countries, but also Europe and, eventually, the United States. The study finds that multiresistant TB has been reported in 100 countries and that its rates are rising faster in some countries than officials had anticipated.