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Quinolones and multidrug-resistant tuberculosis.

K N Maranetra1

  • 1Division of Respiratory Disease and TB, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Chemotherapy
|August 18, 1999
PubMed
Summary

Multidrug-resistant tuberculosis (MDR-TB) treatment in Thailand showed promising results with ofloxacin-based regimens. Ofloxacin demonstrated high efficacy, achieving a 78% success rate and low resistance, offering hope for MDR-TB management.

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Area of Science:

  • Tuberculosis Research
  • Antimicrobial Resistance
  • Pharmacology

Background:

  • The prevalence of multidrug-resistant tuberculosis (MDR-TB) in Thailand from 1993-1997 showed stable trends for initial resistance to isoniazid (INH) and rifampicin (RFP).
  • Acquired MDR-TB demonstrated a slight downward trend, reaching 22.6% in the latest recorded period.

Purpose of the Study:

  • To report the prevalence of initial and acquired multidrug-resistant tuberculosis (MDR-TB) in Thailand.
  • To evaluate the efficacy and safety of ofloxacin in combination regimens for MDR-TB treatment.
  • To assess the resistance patterns of MDR-TB strains to fluoroquinolones.

Main Methods:

  • A clinical trial evaluated a regimen including ofloxacin (600 mg/day), pyrazinamide (PZA), kanamycin (KM) or amikacin (AMK), para-aminosalicylic acid (PAS), and ethambutol (EMB) or thiacetazone for 18 months.
  • Sputum culture conversion rates and treatment success rates were monitored over a two-year follow-up period.
  • Antimicrobial susceptibility testing was performed on MDR-TB isolates for ofloxacin and ciprofloxacin.

Main Results:

  • All tested MDR-TB isolates were sensitive to ofloxacin.
  • Sputum culture conversion was approximately 25% at one month, increasing to 93% by nine months of treatment.
  • The ofloxacin-containing regimen achieved a 78% treatment success rate.

Conclusions:

  • Ofloxacin is a valuable component in MDR-TB treatment regimens, demonstrating high efficacy and low resistance rates.
  • The evaluated ofloxacin regimen significantly improved sputum culture conversion and treatment outcomes in MDR-TB patients.
  • Further research into the role of quinolones in preventing TB transmission among MDR-TB contacts is warranted.

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