Chen TC, Lu PL, Lin CY, Lin WR, Chen YH. Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systematic review and meta-analysis. Int J Infect Dis. 2011 Mar;15(3):e211-6. Epub 2010 Dec 30.

Chen, et al., conducted a meta-analysis to ascertain the answer to two questions: 1)Whether fluoroquinolone prescriptions are associated with delayed diagnosis and treatment of pulmonary TB or 2) whether fluoroquinolone prescriptions are associated with the development of fluoroquinolone-resistant M. tuberculosis.

The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to ensure the robustness of their analysis. Out of the 770 records screened, 33 records were assessed for eligibility and 9 records were included in the meta-analysis. Key points from the article include:

• Infectious Disease Society of America and the American Thoracic Society along with European guidelines recommend the use of fluoroquinolones for treating community-acquired pneumonia; Australia and the UK do not included fluoroquinolones in first-line treatment of pneumonia.
• The meta-analysis determined that there was a 19-day delay in the diagnosis and treatment of TB in patients prescribed fluoroquinolones compared to patients not prescribed fluoroquinolones.
• There was a 2.70-fold risk of patients developing fluoroquinolones-resistant TB strains. The authors note that other researchers found that the risk of resistance increased based on duration of monotherapy with flouroquinolones.
• The study did not look at specific fluoroquinolones, so all (ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, moxifloxacin, and gemifloxacin) were included. A determination could not be made on the effect of a specific fluorquinolone on delays in treatment or resistance.

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