Hospitalization typically lasted until self-cure or death, which could take years. Prior to streptomycin, TB treatment options were limited to convalescence at a TB sanatorium and a suite of surgical techniques. By the 1960s, at least a dozen antibiotics with activity against TB had been discovered, resulting in more effective and quicker treatment.

Streptomycin, the first antibiotic used to treat TB, was discovered in 1944, followed by para-aminosalicylic acid (PAS) in 1946 and isoniazid (isonicotinic acid hydrazide, or INH) in 1952. The discovery of TB chemotherapy, along with intensified efforts at prevention and care, resulted in dramatic reductions in TB mortality by the 1960s.

TB-specific death rates in First Nations communities were as much as ten to twenty times higher than the rates in non-First Nations populations during this time. In the early to mid-twentieth century, First Nations communities of Western Canada experienced severe epidemics of tuberculosis (TB). These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. ConclusionĬounterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. 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 < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. Resultsįirst 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). 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. 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-). MethodsĪnalyses were performed on records of sanatoria admissions and discharges occurring between 19 in Saskatchewan, Canada. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. 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. 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 discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control.

Tb sanitarium