Tuberculosis drug serum levels.

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Abstract
Sir—The fine paper by Narita and colleagues [1] does not show a direct correlation between the serum concentrations of the tuberculosis drugs and the recurrence of tuberculosis disease. It is possible that the use of different break-point values (e.g., one-half of the target ranges) might have yielded different results. Ongoing research sponsored by the Centers for Disease Control and Prevention (Atlanta) suggests that, in certain situations, low serum concentrations of the tuberculosis drugs are associated with worse treatment outcomes. Some of these data were presented at the annual meeting of the American Thoracic Society in May 2001 [2, 3]. The available data suggest that failure of tuberculosis treatment or recurrence of disease results from a complex and poorly understood combination of factors that likely varies from patient to patient. The use of antibiotic serum concentrations rarely has perfect predictive value to guide the choice of drug dosage [4-10]. I would like to suggest an approach to the use of antibiotic serum concentrations that may be useful.