Editorial GRADUAL FILLING UP OF TB DRUG PIPELINE: HOW CAN WE PLAY OUR ROLE BETTER?

agents, hope dawned on the gloomy world of patients of tuberculosis. By the end of the 20th century, the changing disease and patient profiles had necessitated to step-up the global hunt for better and more effective drugs in the changed scenario. The drugs currently in use, given in combination regimens, revolutionized the management and prognosis of TB patients. The situation further brightened with introduction and expansion of the directly observed therapy short-course (DOTS) strategy, but not before years of meticulously planned and painstaking research generated the evidence for change of policy and practice. For example, for over forty years the British Medical Research Council evaluated all the drugs currently in use for treatment. It tested roughly 250 different regimens, enrolling 25 000 patients in trial. Unfortunately, as DOTS coverage expanded, it became apparent that performance of existing drugs limited more efficient implementation of strategy. The duration of treatment required for curing patients could not be reduced to less than six months. In some situations, the regimens are associated with high rates of patients ’ non-adherence with consequences of increased mortality and creation of chronic infectious drug resistance strains. The infrastructure required for DOTS is cumbersome, labour intensive, and expensive which some resource constrained countries find difficult to sustain. The co-infection of TB-HIV, and emergence of MDR an