Fluoroquinolones for the treatment of tuberculosis in children

Thee, Stephanie; Garcia-Prats, Anthony J; Donald, Peter R.; Hesseling, Anneke C.; Schaaf, H. Simon

doi:10.1016/j.tube.2015.02.037

Cited by 49 publications

(26 citation statements)

References 249 publications

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“…67,68 The extended administration of the fluoroquinolones in adults with multidrug-resistant tuberculosis has not shown serious adverse effects, and there is no evidence to date suggesting that this is different in children. 69 A recent systematic review of empirical fluoroquinolone therapy for children with fever and neutropenia found excellent outcomes with short-term safety. It should be emphasized, however, that these data were from studies in patients with low-risk fever and neutropenia (leukemia/lymphoma), of whom only a small proportion would be expected to have a serious occult bacterial infection.…”

Section: Mycobacterial Infectionsmentioning

confidence: 99%

The Use of Systemic and Topical Fluoroquinolones

Jackson¹,

Schutze²

2016

Pediatrics

136

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Appropriate prescribing practices for fluoroquinolones, as well as all antimicrobial agents, are essential as evolving resistance patterns are considered, additional treatment indications are identified, and the toxicity profile of fluoroquinolones in children has become better defined. Earlier recommendations for systemic therapy remain; expanded uses of fluoroquinolones for the treatment of certain infections are outlined in this report. Prescribing clinicians should be aware of specific adverse reactions associated with fluoroquinolones, and their use in children should continue to be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone treatment represents a reasonable alternative to parenteral antimicrobial therapy.

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Section: Mycobacterial Infectionsmentioning

confidence: 99%

The Use of Systemic and Topical Fluoroquinolones

Jackson¹,

Schutze²

2016

Pediatrics

136

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“…The proportions of uoroquinolones (such as OFX, MFX and LFX) were identi ed to be higher than our previous investigation in adult TB cases in Sichuan [36]. Though various adverse effects have been reported [37,38], uoroquinolones are still considered as key components of current MDR-TB regimens [39]. The certain numbers of resistance to uoroquinolones among new child TB cases are likely from the MDR-TB patients with uoroquinolones treatment, which should be concerned for their impact on the circulation patterns of DR-TB strains in this area.…”

Section: Discussionmentioning

confidence: 67%

The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015-2018: A retrospective study

Zhu³

et al. 2020

Preprint

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Background: The aim of this study was to investigate the epidemiological characteristics and profile of drug-resistant tuberculosis (DR-TB) among children with TB in Sichuan province of China.Methods: From January 2015 to December 2018, microbiological culture-confirmed child TB cases (aged<15 years old) were enrolled retrospectively. Epidemiological and clinical information from these cases, and the drug susceptibility testing (DST) results of the isolates were collected and analyzed.Results: Of 317 culture-confirmed child TB cases, 16.7% (53/317) were aged under 5 years old. 54.9% were Tibetans, and 31.9% had clear history of contact with TB patients. More than half (53.9%) weren’t vaccinated by Calmette–Guérin bacillus (BCG). 30% (n=95) were diagnosed as severe TB, and 92.4% (n=293) were new cases. The ratio of severe TB in BCG vaccinated group was significant lower than that observed in unvaccinated group (p<0.01). Significantly higher proportion of severe TB among Tibetans than Han child TB cases was observed in BCG unvaccinated group (p<0.01). The overall rate of DR-TB in this study was 24.3% (77/317) and 17 multidrug-resistant tuberculosis (MDR-TB) cases were identified with rate of MDR-TB at 5.4% (17/317). No XDR case was found. 13 out of 17 MDR-TB cases (76.4%) were Tibetan children. The ratio of any resistance to four first-line drugs identified were: INH, 15.5%; RIF, 9.1%; EMB, 0.6% and SM, 6.0%, respectively. More than half of MDR patterns were resistant to INH+RIF (9/17), followed by at least resistance to INH+RIF+SM (n=7). Conclusions: This was the first investigation on the epidemiological characteristics and profiles of DR-TB among child TB cases in Southwest of China. Our findings indicated a potentially high risk of TB infection to Tibetan children in the concentrated Tibetan communities of Sichuan.

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“…Fluoroquinolones exhibit their efficacy via interference with bacterial DNA replication, transcription and repair by inhibition of DNA gyrase and Topoisomerase IV [126–128]. Discovered in a drug repurposing study, Moxifloxacin has previously been used to treat respiratory tract infections.…”

Section: New Drugsmentioning

confidence: 99%

“…If proven to be equally or more efficacious to standard care, it could stand as a huge breakthrough for HIV/TB co-infected patients, as RIF would not be involved in the therapy to interact with anti-retrovirals common to HIV treatments. There is little data for the treatment of drug-susceptible TB with fluoroquinolones in pediatrics, but there is a recent review of the treatment of MDR-TB in pediatrics [128] with an example regimen largely containing Ofloxacin (96%) for 13 months that achieved a cure in 137 of 149 children [129] and several others that achieved similar positive outcomes using Levofloxacin and Moxifloxacin. This recent influx of pediatric data for these repurposed drugs holds great promise as these classes are currently undergoing optimization for their anti-TB efficacy.…”

Section: New Drugsmentioning

confidence: 99%

Advances in Drug Discovery and Development for Pediatric Tuberculosis

Hoagland¹,

Zhao²,

Lee

2016

MRMC

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Pediatric tuberculosis is an underappreciated global epidemic estimated to afflict around half a million children worldwide. This problem has historically been overlooked, due in part to their low social status and the difficulty in diagnosis of tuberculosis in children. Children are more susceptible to tuberculosis infection and disease progression, including rapid dissemination into extra-pulmonary infection sites. Treatment of pediatric tuberculosis infections has been traditionally built around agents used to treat the adult disease, but the disease pathology, drug pharmacokinetics and the safety window in children differs from the adult disease. This produces additional concerns for drug discovery and development of new agents. This review examines: (i) the safety concerns for current front and second line agents used to treat complex drug resistant infections and how this knowledge can be used to identify, prioritize and dose agents that may be better tolerated in pediatric populations; (ii) the chemistry and suitability of new drugs in the clinical development pipeline for tuberculosis for the treatment of pediatric infections indicating several new agents may offer significant improvements for the treatment of multi-drug resistant tuberculosis in children.

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Fluoroquinolones for the treatment of tuberculosis in children

Cited by 49 publications

References 249 publications

The Use of Systemic and Topical Fluoroquinolones

The Use of Systemic and Topical Fluoroquinolones

The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015-2018: A retrospective study

Advances in Drug Discovery and Development for Pediatric Tuberculosis

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