Long Term Antimicrobial Therapy Without Collapse: 300 Cases of Pulmonary Tuberculosis Treated for One Year or Longer

¹ The William H. Maybury Sanatorium, Northville, Michigan.

The advancing age of sanatorium populations carries with it definite clinical problems. Since 1951 at Maybury Sanatorium, 137 poor prognosis, salvage patients have been treated with long-term antimicrobials. They were older white males, for the most part, with far advanced fibrocavernous disease of long standing. Results are compared with 163 similarly treated patients with less destructive disease of shorter duration. As regards cavity closure, x-ray improvement and time of discharge, the salvage group lagged far behind the nonsalvage. But in sputum conversion, the salvage group was only slightly less impressive. The achievement of stable roentgenograms, negative sputum cultures and acceptable clinical status in over three-fourths of their number justifies the prolonged use of antimicrobials in individuals with apparently poor prognosis. For the patient whose disease has stabilized but still is of such major proportion that therapy must be extended indefinitely, the concept of a maintenance dose is introduced. Such therapy in selected cases is a promising means of preserving therapeutic gains.