Medication monitors to treat tuberculosis. A supplement to directly observed therapy.

The use of directly observed therapy (DOT) for nearly all cases of pulmonary tuberculosis (TB) is being widely promoted by the Centers for Disease Control, but its implementation is being resisted by many health professionals. Consequently, less than half of the patients in major metropolitan health departments were given DOT in 1996. The usual justification for "universal" DOT instead of selective DOT is the well-known difficulty in differentiating between patients who are reliable in taking medication from those who are not. Devices called medication monitors, which record when medication is removed from a container, were shown to be effective in determining the reliability of TB patients in taking medication in the 1960s but were cumbersome to use. Since then several improved, convenient to use, electronic medication monitors have been introduced and further improvements can be anticipated. These increasingly practical medication monitors need to be studied as a supplement to DOT in order to make selective DOT an effective alternative to "universal" DOT in managing the medication compliance problem when treating TB.