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Editorial |

Resistance to Antituberculosis Medications:  Hard Lessons to Learn

Donald A. Enarson, MD
Arch Intern Med. 2000;160(5):581-582. doi:10.1001/archinte.160.5.581.
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TWO ARTICLES concerning drug resistance in patients from Mexico published in this issue of the ARCHIVES1,2 highlight key challenges to a global strategy for tuberculosis control.

Mexico has clearly reduced the tuberculosis problem from historically higher levels,3 evidenced by the character of the current epidemiological picture of the disease as primarily affecting older men and high-risk groups.2 Despite recommendations by international authorities, the policies implemented thus far appear limited and in need of revision if Mexico is to achieve success against tuberculosis. This is evidenced by the high proportion of the most highly infectious (smear-positive) patients who have already gone through the system without having been permanently cured, a relatively high level of resistance to the medications available for treatment, and the consequent negative impact on treatment results. Furthermore, the failure to implement a unified surveillance system for all tuberculosis cases in the country limits the ability of the government itself to detect the consequences of the inappropriate policies that are currently in place. Finally, and most importantly, much of this could have been avoided1 if the government had adopted or would fully adopt the recommendations of international scientific bodies4,5 for the treatment of tuberculosis patients.

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