Interventions for Tuberculosis Control and Elimination 2002

Number of viable bacilli
Mutants
resistant
to A
Lag due to drug A
Lag due to
drug B
Killing phase Regrowth
combination is the randomized controlled clinical trial, whereby a group of
patients is randomly assigned to the new regimen (experimental arm) or to
the standard regimen (control arm). The element of randomization to reduce
selection bias was actually first introduced in tuberculosis, with the first
streptomycin trial of the British Medical Research Council. 465,473,474
Clinical trials have been conducted all over the world by different organizations
and institutions. However, there can be little doubt that the leading
role in the development of modern chemotherapy against tuberculosis
was taken by the British Medical Research Council and its collaborators
throughout the world, 122,475 and by the United States Public Health Service
and the United States Veterans Administration. 476
While the efficacy of anti-tuberculosis treatment was fully appreciated,
it is noteworthy that tuberculosis was for a long time not considered to be
curable; temporary remission and prevention of emergence of resistance
were the primary objectives for a long time. This is particularly surprising
as it had been shown already in the 1950s that tuberculosis is curable
using appropriate combination therapy. 477,478
In the following, only the highlights leading up to modern chemotherapy
are summarized. For a more detailed account, the comprehensive
review by Fox and collaborators from the British Medical Research
60
Regrowth starting
Figure 41. Bacteriopausal effects during regrowth of M. tuberculosis. Reproduced
from 464 by the permission of the publisher International Union Against Tuberculosis
and Lung Disease.