Tuberculosis sanatorium treatment at the advent of the chemotherapy era

• Main Authors: Zwick, Erin D., Pepperell, Caitlin S.
• Format: Article in Journal/Newspaper
• Language: unknown
• Published: figshare 2020
• Subjects: Medicine; Pharmacology; Biotechnology; Sociology; FOS Sociology; Science Policy; 110309 Infectious Diseases; FOS Health sciences; Canada; First Nations
• Online Access: https://dx.doi.org/10.6084/m9.figshare.c.5204854; https://springernature.figshare.com/collections/Tuberculosis_sanatorium_treatment_at_the_advent_of_the_chemotherapy_era/5204854

Abstract Background The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. Methods Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944–1946), dual-therapy (Streptomycin and PAS, 1946–1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. Results First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p