Drug-Resistant TB Could Bring Back Sanatoria

Before the advent of antibiotics, people with infectious diseases like tuberculosis were sent to sanatoria – secluded hospitals that healed through good food, fresh air and sunlight. The isolated buildings also quarantined infected patients, thwarting the spread of contagious and dangerous diseases.

In the ’60s, rifampicin removed the need for sprawling sanatoria — some of which, like the Sondalo Tuberculosis Hospital in Italy, housed several thousands of patients. But the recent emergence of new, antibiotic-resistant strains of the disease-causing bacteria in South Africa has prompted a call for the return of sanitoria.

“The time for rebuilding so-called new sanatoria under a new vision has come and is overdue,” Keertan Dheda of the University of Cape Town and Giovanni Migliori of the World Health Organization Collaborating Center for TB and Lung Diseases proposed in a commentary published today in Lancet Infectious Diseases. “We have now come full circle and once again there are large numbers of patients for whom there are no effective antituberculosis drugs. The pool of untreatable cases is accumulating and will need swift action to avoid a human catastrophe.”

Like other superbugs, antibiotic-resistant tuberculosis does not succumb to typical treatments. And left untreated, infected patients can readily pass the sinister strain of bacteria onto family members and others in their communities.

“How should we deal with these people who are living with failed treatment and who still have the capacity to transmit disease,” Dheda and Migliori wrote. “Is the discharging of these patients, who often live in a single room with many other family members, into impoverished communities justifiable?”

Drug-resistant tuberculosis is not a public health problem in the United States, thanks in part to the strict supervision of at-home tuberculosis treatment. Skipping doses can lead to antibiotic resistance, according to Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center.

“By having health care workers go out and supervise the administration of drugs to our patients, we make sure they keep taking their medications as directed,” said Schaffner. The supervision, part of a treatment effort called “directly observed therapy,” ensures patients finish their course of antibiotics – even if they feel better early in the course.

But in regions of the world increasingly burdened by drug-resistant tuberculosis, the idea of sanatoria may be worth revisiting.

“It’s a reasonable question: at what point do you have enough drug resistance that sanatoria should be considered?” said Schaffner.  “In South Africa and some Eastern European countries, sanatoria might be a reasonable choice.”