Previous use of quinolones: a surrogate marker for first line anti-tuberculosis drugs resistance in HIV-infected patients?

Abstract

HIV Quinolones Drug resistance A B S T R A C TObjectives: Drug resistant Mycobacterium tuberculosis causes much higher rates of treatment toxicity, failure or relapse, and mortality. We determined the drug resistant profile of Mycobacterium tuberculosis strains isolated from a population of HIV-infected patients in southern Brazil and studied the potential factors associated with resistance. Methods:We conducted a retrospective cohort study to determine the resistance profile of Mycobacterium tuberculosis isolated from HIV-infected patients and factors that could be associated with resistance from 2000 to 2005.Results: 236 patients were included in the study. Resistance to at least one drug was observed in 32 (14.6%) isolates, and multi-drug resistance was observed in 4 (1.82%) isolates. On multivariate analysis, previous use of tuberculostatics and quinolones were related to any first-line drug resistance. Conclusions:In our study, previous quinolone use was significantly associated to first-line anti-TB drugs resistance. Multi-drug-resistant tuberculosis (MDR-TB) is a major problem worldwide, and we believe quinolones should be used with caution in settings where TB is endemic.

Multidrug resistant tuberculosis: Understanding the past for the better future

“…It has been found in a study that if fluoroquinolone is used even for few days in patients has been found as a surrogate marker of MDR-TB. [16] In a study, resistance to at least one of the second-line drug in MDR-TB patients was found as high as 44%, at the start of MDR-TB treatment itself, which might be due to rampant addition of reserve line drugs to the regimens of first-line antitubercular drugs in patient with hope of quick response. [17] Considering this nonjudicious use of reserve line drugs by the treating doctors, the authors of the study had recommended scaling up the DST facility of second line drugs and also advocated for individualized treatment regimen based on DST pattern, which might be seen as the ideal scenario for treating MDR-TB patients but may be quite difficult to achieve due to such a high number of MDR-TB patients in India and lack of adequate knowledge about the diagnosis and prescription of MDR-TB, as was found in a study, in which only six out of 106 doctors were able to write down correct prescription of MDR-TB in terms of regimen, duration, and dosage.…”