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Fluoroquinolones for treating tuberculosis.

L E Ziganshina1, S B Squire

  • 1Kazan State Medical Academy for Postgraduate Medical Education, Clinical Pharmacology and Pharmacotherapy, 11 Mushtari Street, 420012, Kazan, Tatarstan, Russia. lezign@mail.ru

The Cochrane Database of Systematic Reviews
|February 7, 2008
PubMed
Summary
This summary is machine-generated.

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Fluoroquinolones show no significant difference in treating tuberculosis, but ciprofloxacin use may increase relapse rates, especially in HIV-positive individuals. Further trials on newer fluoroquinolones are needed.

Area of Science:

  • Pharmacology and Infectious Diseases
  • Clinical Trials and Evidence-Based Medicine
  • Microbiology and Drug Resistance

Background:

  • Fluoroquinolones are utilized in treating both drug-sensitive and multidrug-resistant tuberculosis.
  • Assessing the efficacy and safety of fluoroquinolones within tuberculosis treatment regimens is crucial.

Purpose of the Study:

  • To evaluate fluoroquinolones as supplementary or replacement agents in antitubercular drug regimens.
  • To assess their impact on both drug-sensitive and drug-resistant forms of tuberculosis.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases including Cochrane, MEDLINE, EMBASE, LILACS, and others up to July 2007.
  • Included RCTs involving bacteriologically confirmed pulmonary tuberculosis treated with fluoroquinolone-containing regimens.

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Main Results:

  • Eleven trials with 1514 participants were analyzed.
  • No significant difference in cure, failure, or improvement rates when substituting ciprofloxacin, ofloxacin, or moxifloxacin for first-line drugs.
  • Ciprofloxacin substitution in drug-sensitive tuberculosis was linked to higher relapse rates and longer culture conversion times, particularly in HIV-positive patients.
  • Substitution for ethambutol increased adverse events. Levofloxacin addition/substitution showed no effect in drug-resistant cases. Sparfloxacin and ofloxacin showed no significant differences.

Conclusions:

  • Limited fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, moxifloxacin) have been evaluated in RCTs for tuberculosis.
  • Ciprofloxacin is not recommended for tuberculosis treatment based on current evidence.
  • Ongoing trials are investigating newer fluoroquinolones; sparfloxacin and ofloxacin demonstrated comparable outcomes in drug-resistant tuberculosis.