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Current prospects for the fluoroquinolones as first-line tuberculosis therapy
1Laboratorio de Genética Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Km 11, Carr Panamericana, Caracas 1020A, Venezuela. htakiff@ivic.gob.ve
Antimicrobial Agents and Chemotherapy
|August 31, 2011
Summary
Fluoroquinolones (FQs) show promise for shortening tuberculosis (TB) treatment. However, restricting FQ use for non-specific respiratory symptoms is crucial to prevent fluoroquinolone-resistant TB.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Fluoroquinolones (FQs) are effective against multidrug-resistant tuberculosis (MDR TB).
- Preclinical studies suggest FQs may shorten treatment duration for drug-susceptible TB when used as first-line agents.
- Phase II trials yielded mixed results, though some showed improved early sputum conversion rates when moxifloxacin replaced ethambutol.
Purpose of the Study:
- To evaluate the potential of FQ-containing regimens for treating tuberculosis.
- To address concerns regarding the development of FQ resistance with increased FQ use.
- To inform optimal strategies for FQ deployment in high-TB-burden regions.
Main Methods:
- Review of phase II trial data on FQ-containing regimens.
- Analysis of studies examining FQ use prevalence and FQ-resistant TB rates.
- Consideration of clinical observations regarding FQ use for non-specific respiratory symptoms.
Main Results:
- Some studies indicate increased early sputum conversion with FQs replacing ethambutol.
- Despite widespread FQ use, FQ-resistant TB prevalence appears low, with predominantly low-level resistance.
- A principal risk for resistance emerges when FQs treat undiagnosed TB presenting as non-specific respiratory illness.
Conclusions:
- Ongoing phase III trials will determine the future of FQs as first-line TB therapy.
- Restricting FQ use for community-acquired pneumonias in high-TB-burden areas is recommended.
- Monitoring FQ-resistant TB prevalence and ensuring cost-effectiveness are vital for successful FQ implementation.
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