DOTS and DOTS-plus: not the only answer.

Multidrug-resistant tuberculosis is already a global pandemic, with focal "hot spots" of ongoing transmission. Although DOTS (directly observed treatment, short course) chemotherapy is the goal of global tuberculosis control, short-course chemotherapy will not cure multidrug-resistant tuberculosis. In settings of high transmission of multidrug-resistant tuberculosis, "DOTS plus" (a complementary DOTS-based strategy with provisions for treating multidrug-resistant tuberculosis) is warranted. DOTS-plus project implementation to date reveals important clinical, epidemiological, and economic lessons. Community-based strategies designed to enhance local capacity are cost effective and make it possible to meet new medical challenges.