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Comparision between "standardized" and individualized treatment regimens

Posted by plosmedicine on 31 Mar 2009 at 00:03 GMT

Author: Stobdan kalon
Position: Dr.
Institution: Medecins Sans Frontiers
Submitted Date: December 12, 2006
Published Date: December 13, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

It is known that the "standardized" regimen used in Peru was in fact quite an ill designed one and had lower success outcomes. So how valid is the use this poor example treatment regimen to generalize all standardized regmens?

With the lack of enough evidence base, I feel its too early to conclude upon the superiority of Individualised treatment regimens (ITR) over standardized ones in terms of cost-effectiveness, considering the following.

1) The promising outcomes of some standardized regimens e.g. (Van Deun A.; Hamid Salim M.A.; Kumar Das A.P.; Bastian I.; Portaels F Results of a standardised regimen for multidrug-resistant tuberculosis in Bangladesh. The International Journal of Tuberculosis and Lung Disease, Volume 10, Number 8, August 2006, pp. 827-827.)

2) It is very obvious that standardized treament regimens (STR) are less resource intensive compared to ITR in terms of material (mainly laboratory), humam resources, and time spent over individual patients.

3) The low wastage of drugs in STR compared ITR, which in resource limited setting is a logistical nightmare to forecast 2nd line drug requirement

4) The greater sustainability of STR as it is easier to sustain a simpler approach comared to ITR which requires consistent specialised skills

It is clear that response against MDR TB needs to be scaled up integrated with efforts to improve the control of drug susceptible TB. But it would be crucial that we follow the most feasible approach to address this problem. The study by Resch SC has contributed to this scarce evidence base and we need many more of studies like this comng from diferent stakeholders for better understanding of these issues.

No competing interests declared.