Fluoroquinolones for treating tuberculosis (presumed drug-sensitive)

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Trials

Background:

• Current World Health Organization guidelines recommend fluoroquinolones for drug-sensitive tuberculosis (TB) only when standard first-line drugs are not tolerated.
• Fluoroquinolones hold potential for shortening TB treatment duration and improving patient outcomes.
• This review synthesizes evidence on fluoroquinolone use within first-line TB regimens.

Purpose of the Study:

• To evaluate the efficacy and safety of fluoroquinolones as substitute or additional components in antitubercular drug regimens for drug-sensitive TB.
• To assess the impact of fluoroquinolones on treatment outcomes such as death, relapse, and sputum conversion.

Main Methods:

• Systematic search of multiple databases including Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, Science Citation Index, and others up to March 2013.
• Inclusion of randomized controlled trials (RCTs) comparing antitubercular regimens containing fluoroquinolones with standard first-line regimens (based on rifampicin and pyrazinamide) for drug-sensitive pulmonary TB.
• Data extraction, risk of bias assessment, and analysis using risk ratios and fixed-effect models where appropriate, with GRADE approach for evidence quality assessment.

Main Results:

• Five RCTs with 1330 participants were included; none evaluated regimens shorter than six months.
• Adding levofloxacin to standard regimens showed uncertain effects on death, sputum conversion, and adverse events (very low quality evidence).
• Substituting ethambutol or isoniazid with fluoroquinolones yielded uncertain or minimal effects on key outcomes like death, relapse, and sputum conversion (very low to low quality evidence).

Conclusions:

• Current evidence is insufficient to determine if fluoroquinolones (ofloxacin, levofloxacin, moxifloxacin, gatifloxacin) improve outcomes when added or substituted in standard first-line drug-sensitive TB regimens.
• The impact on death, relapse, and sputum conversion remains unclear due to limited and low-quality evidence.
• Ongoing trials investigating shorter, four-month fluoroquinolone-containing regimens are crucial for future understanding.