A 5-year study of patients with pulmonary tuberculosis in a concurrent comparison of home and sanatorium treatment for one year with isoniazid plus PAS.
Dawson, J.J.Y.; Devadatta, S.; Wallace Fox; Radhakrishna, S.; Ramakrishnan, C.V.; Somasundaram, P.R.; Stott, H.; Tripathy, S.P.; Velu, S.
Bulletin of the World Health Organization; 1966; 34; 533-551 and Indian Journal of Tuberculosis; 1966; 13; 168-184.
This report from Tuberculosis Chemotherapy Centre, Madras, summarizes the progress over a 5-year period of 193 patients with newly diagnosed, sputum-positive pulmonary tuberculosis who were admitted to a concurrent comparison of home and sanatorium treatment for one year with isoniazid plus PAS. Previous reports have shown that, despite the traditional advantage of sanatorium treatment-rest, adequate diet, nursing and supervised drug-administration-the home patients responded nearly as well as the sanatorium patients in the first year; further, the relapse rates over a 2-year period of follow-up were similar. The findings in the present report are based on a 4-year period of follow-up and extent these conclusions, the relapse rates over the period being 7% for the home patients and 10% for the sanatorium patients.
The patients who failed to respond to treatment in the first year and those who had a bacteriological relapse in the second or subsequent years were usually re-treated with reserve regimens, first with streptomycin plus pyrazinamide and, if this was ineffective, with cycloserine plus ethionamide. Considering the findings over the entire 5-year period, five home patients and three sanatorium patients died from non-tuberculous causes. Of the remainder, 5% of the home patients and 6% of the sanatorium patients died of tuberculosis, 4% in each series had bacteriologically active disease at fifth year and 90% and 89%, respectively, had bacteriologically quiescent disease at that time. These findings are very encouraging, particularly for developing countries such as India, where tuberculosis is a major problem and sanatorium beds are very few.
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