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TB R&D Weekly Update: TB Drug Resistance and Treatment Delays with Fluoroquinolone Use for Pneumonia

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.

Additional TB R&D News:

New ECDC and WHO joint report on TB: concern about multi drug-resistance and childhood TB

Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study

Drug-resistant TB rising in Europe

Study raises TB vaccine hopes

Scientists Find Way To Use Tuberculosis Bacteria To Combat Cancer

Tuberculosis Findings At Russian Academy Of Sciences Workshop In Rio De Janeiro, Brazil

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