Abstract

A systematic review and meta-analysis were conducted in order to compare the effectiveness of directly observed therapy, short-course (DOTS) with self-administered treatment (SAT) in people with pulmonary tuberculosis. PubMed, Embase, ISI Web of Science, and the Scielo/Lilacs were searched for studies published between 1 January 1965 and 31 December 2013. Eleven studies were selected, including 14390 people with the following outcomes: cure, treatment completion or abandonment, and death. Results showed that approximately 22% more healing and completed treatment occurred among patients who underwent SAT (OR 1.22, 95% CI 1.07 to 1.40), while a lower treatment dropout rate was found in the group receiving DOTS (OR 0.68, 95% CI 0.56 to 0.83). Results did not detect a significant difference in the risk of death when comparing SAT and DOTS (OR 0.82, 95% CI 0.64 to 1.05). In the discussion, a reflection is made on what kind of treatment regimen is best suited to those infected by Mycobacterium tuberculosis and a discussion ensues on how to achieve better cure rates and less abandonment and mortality. It is concluded that when choosing a treatment regimen for patients, public programs are key to considering the dynamics of health services as well as the conditions and lifestyle of patients. The latter must also provide prevention, treatment and monitoring of infection, and have sufficient funding to train a health team and ascertain follow up of patients and families in order to attain the best success rates possible.

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