To the Editor:

In the June issue of the European Respiratory Journal (ERJ), A. Skrahina and co-workers reported alarming rates of multidrug-resistant tuberculosis (MDR-TB) in Minsk, Belarus. In their survey, they diagnosed MDR-TB in 35.3 % of new patients and 76.5 % of previously treated patients [1]. The reflex response to such figures is to strengthen classical infection control activities, to intensify case detection, and to strengthen adherence to and rational use of the first-line antituberculosis regimen. Unfortunately, with the MDR-TB rates now emerging from Eastern Europe and Central Asia, it is questionable how appropriate the current first-line regimen and its rigid use in newly diagnosed cases are in that setting. Is it not time to consider an entirely new first-line treatment for countries or regions where, for example,.25 % of tuberculosis in pre-viously untreated patients is MDR-TB? In a different setting