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Updated: Aug 12, 2026
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The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
Published on: August 11, 2008
The WHO/IUATLD diagnostic algorithm for tuberculosis and empiric fluoroquinolone use: potential pitfalls
1Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A4103 Medical Center North, Nashville, TN 37232-2605, USA. timothy.sterling@vanderbilt.edu
Summary
Empiric fluoroquinolone monotherapy for suspected tuberculosis can delay diagnosis and promote drug resistance. Current guidelines should be revised to prevent inappropriate use and protect tuberculosis treatment options.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- The World Health Organization/International Union Against Tuberculosis and Lung Disease (WHO/IUATLD) diagnostic algorithm for tuberculosis requires failure to respond to broad-spectrum antibiotics before diagnosing smear-negative pulmonary disease.
- Fluoroquinolones possess broad-spectrum activity against respiratory pathogens and Mycobacterium tuberculosis, leading to their common use in community-acquired pneumonia.
Purpose of the Study:
- To evaluate the impact of empiric fluoroquinolone monotherapy on tuberculosis diagnosis and resistance.
- To recommend revisions to WHO/IUATLD guidelines regarding fluoroquinolone use in smear-negative tuberculosis.
Main Methods:
- Literature review and analysis of current diagnostic protocols for tuberculosis.
- Assessment of the clinical and microbiological implications of fluoroquinolone use in patients with suspected tuberculosis.
Main Results:
- Empiric fluoroquinolone monotherapy is associated with delayed diagnosis of tuberculosis.
- This practice contributes to the development of fluoroquinolone resistance in Mycobacterium tuberculosis.
- Delayed diagnosis and treatment of tuberculosis increase patient morbidity and mortality.
Conclusions:
- Fluoroquinolone resistance in M. tuberculosis threatens the utility of this drug class for tuberculosis treatment.
- WHO/IUATLD diagnostic criteria for smear-negative tuberculosis require revision to prevent inappropriate fluoroquinolone use.
- Revised guidelines are crucial to avoid detrimental effects of empiric fluoroquinolone monotherapy and preserve future treatment options.
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