A concurrent comparison of home and sanatorium treatment of pulmonary tuberculosis in South India
Anonymous
Bulletin of the World Health Organization 21(1): 51-144
1959
ISSN/ISBN: 0042-9686 PMID: 20604054 DOI: 10.1016/s0041-3879(59)80104-5Document Number: 522074
Patients (193) were admitted to a comparison of treatment at home (96 patients) with treatment in sanatorium (97 patients) for a period of 12 months beginning 24 Sept., 1956; the patients being allocated at random to one of these 2 treatment series. Patients in both series were given the same chemotherapy for the 12 months-namely, isoniazid 200 mg plus PAS (sodium) 10 g daily (given together in the same cachet in two doses) for patients weighing 100 lb. (45 kg) or more. The dosage was reduced for lighter patients, the range of dosage being from 3.7 to 6.6 mg isoniazid/kg body-weight and from 0.19 to 0.33 g PAS (sodium)/kg body-weight. Although all the survivors were examined at 12 months, the main analysis in this report concerns the 82 home and 81 sanatorium patients who (a) had organisms sensitive to the 2 drugs, (b) had had little or no previous chemotherapy and (c) followed the allocated treatment regimen. On admission to treatment, and in spite of the random allocation of treatment, the home series had more severe disease than the sanatorium series in respect of extent of cavitation, total extent of the disease, and bacterial content of the sputum, although the series were similar in other respects; the pre-treatment differences between the series were greater for females than for males. Complete and detailed data are given concerning the patients, their environments, their clinical status and the course of their disease and treatment at home and in the sanatorium. Statistical standardization of the results, to make allowance as far as possible for the pretreatment differences suggests that the radiographic progress was similar for patients with similar pretreatment lesions, whether male or female, but there was a persistent bacteriological disadvantage to the females at home. The results of domiciliary chemotherapy, as carried out in this study, approach sufficiently closely the results of sanatorium treatment to suggest that it is appropriate to treat the majority of patients at home. In formulating this conclusion, consideration has been given to the manifest advantages of sanatorium treatment -namely, rest, diet, nursing and supervised medicine-taking-on the one hand, and the social disadvantages, as represented by the disruption to family life and the difficulty of presuading patients to remain in sanatorium, on the other. It is recognized that the standards of medical care during this study were very favorable, but it is considered that comparable results should be obtainable from a domiciliary service which is being operated from a tuberculosis clinic, provided that certain minimum requirements are met. Among these are an adequate supply of antituberculosis drugs, enough staff, including a public health nurse and a social worker, transport (including an ambulance), a small number of hospital beds for special cases, an efficient appointment system of surprise checks on the cooperation of the patients in taking their medicines, reliable smear examinations of sputum for tubercle bacilli, and a welfare fund for especially needy patients.