Davies Peter D O
Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool, UK.
Am J Respir Med. 2003;2(3):203-9. doi: 10.1007/BF03256649.
Directly Observed Therapy Shortcourse (DOTS) is composed of five distinct elements: political commitment; microscopy services; drug supplies; surveillance and monitoring systems and use of highly efficacious regimens; and direct observation of treatment. The difference in the way the term 'DOTS' as defined by WHO and interpreted by many observers has led to some misunderstanding. WHO generally uses the term to mean the five components of DOTS. But the word 'DOTS' is an acronym for Directly Observed Therapy Shortcourse. Many workers therefore interpret DOTS purely as direct supervision of therapy. DOTS is not an end in itself but a means to an end. In fact it has two purposes, to ensure that the patient with tuberculosis (TB) completes therapy to cure and to prevent drug resistance from developing in the community. The main criticism of DOTS rightly derives from the fact that some properly conducted randomized, controlled trials of directly observed therapy with or without the other components have shown no benefit from it. The problem is that it is impossible to design a study of modern directly observed therapy against the previous self-administered, poorly-resourced programs. As soon as a study is implemented, the attention to patients in the control (non-directly observed therapy) arm inevitably improves from the previous non-trial service situation. What is of concern is that in some trials less than 70% cure rates were achieved even in the direct observation arm. With no new drugs or adjuvant treatment available to bring the length of treatment down to substantially less than 6 months, DOTS offers the best means we have at our disposal for TB control.
直接观察治疗短程疗法（DOTS）由五个不同要素组成：政治承诺；显微镜检查服务；药品供应；监测和监督系统以及使用高效治疗方案；以及治疗的直接观察。世界卫生组织（WHO）所定义的“DOTS”与许多观察者所理解的方式存在差异，这导致了一些误解。WHO通常用该术语指代DOTS的五个组成部分。但“DOTS”这个词是直接观察治疗短程疗法的首字母缩写。因此，许多工作人员纯粹将DOTS理解为对治疗的直接监督。DOTS本身并非目的，而是达成目的的一种手段。事实上，它有两个目的，一是确保结核病患者完成治疗以实现治愈，二是防止社区中产生耐药性。对DOTS的主要批评恰如其分地源于这样一个事实，即一些对有或没有其他组成部分的直接观察治疗进行的、恰当实施的随机对照试验并未显示出其益处。问题在于，不可能针对以前自行给药、资源匮乏的方案来设计现代直接观察治疗的研究。一旦开展一项研究，对照（非直接观察治疗）组对患者的关注必然会比以前的非试验服务状况有所改善。令人担忧的是，在一些试验中，即使在直接观察组，治愈率也不到70%。由于没有新药或辅助治疗可将治疗时长大幅缩短至不到6个月，DOTS是我们可用于结核病控制的最佳手段。
