Moxifloxacin versus Ethambutol in the First 2 Months of Treatment for Pulmonary Tuberculosis

Burman, William J.; Goldberg, Stefan; Johnson, John L.; Muzanye, Grace; Engle, Melissa; Mosher, Ann; Choudhri, Shurjeel; Daley, Charles L.; Munsiff, Sonal S.; Zhao, Zhen; Vernon, Andrew; Chaisson, Richard E.

doi:10.1164/rccm.200603-360oc

Cited by 269 publications

(190 citation statements)

References 27 publications

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“…Higher doses of rifampicin have been found to have better bactericidal activity (Diacon et al, 2007). Fluoroquinolones are recommended for treatment of MDRTB but new methoxyfluoroquinolones (gatifloxacin and moxifloxacin) are being evaluated for treatment shortening of drug susceptibility when substituted for ethambutol or isoniazid (Conde et al, 2009, Burman et al, 2006 New and treatment shortening studies face 2 major challenges: available 6 months regimens are effective and therefore shortening trials have to be non-inferiority trials thus requiring large samples sizes hence expensive to conduct. TB therapy is by combination, therefore, new drugs have to be effective on their own however their clinical use can only be after they are integrated into combinations.…”

Section: Treatment Shortening and New Att Drugs Studiesmentioning

confidence: 99%

Advances in the Diagnosis, Treatment and Control of HIV Associated Tuberculosis

Kirenga¹,

Chanda²,

Muwonge³

et al. 2012

African Journal of Infectious Diseases

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SummaryThere has been an increase in the number of published tuberculosis/HIV (TB/HIV) research findings in recent times. The potential impact of these findings on routine care has informed this review which aims at discussing current concepts and practices underpinning TB/HIV care and control. Any HIV infected person with a cough of any duration is currently considered a TB suspect. Preliminary results also show that the diagnostic yield of same day sputum samples (front loading) is comparable to two-day samples. Laboratory diagnosis is shifting from Ziehl-Neelsen (ZN) smear microscopy and solid culture to fluorescent microscopy, molecular tests and liquid culture. Concomitant TB/HIV therapy improves survival and WHO has recommended ART for all TB/HIV patients. Unless CD4 cell counts are less than 50 cells/µl, ART can be deferred until end of intensive phase. Evidence of survival benefit at high CD4 cell counts is still lacking. New TB drugs and treatment shortening studies are underway but so far no new TB drugs has been added to the current arsenal and treatment duration still remains six months or more. WHO has recommended the 3Is (intensified TB case finding, isoniazid prophylaxis and infection control) for TB/HIV control in addition to effective therapy, Antiretroviral therapy and TB vaccines. There has been immense progress in TB/HIV research, however optimal management of HIV-Infected TB patients, will require further research and appropriate translation of emerging evidence to policy and practice. IntroductionThe burden of tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons continues to represent a major public health problem. Of the 9.4 million new TB cases reported in 2009, 1.1 million were HIV infected of which 380, 000 died (WHO Global Tuberculosis control report, 2010). Antiretroviral therapy (ART) reduces person and population risk of TB by 90% and 60% respectively (Lawn S et al., 2005, Badri et al., 2002. Unfortunately only 37% of TB/HIV patients who qualified to receive ART were initiated on ART in 2009 (WHO Global Tuberculosis control report, 2010). There has been an increase in basic, clinical and public health TB/HIV research, shedding new light on diagnosis, treatment and control of TB/HIV; hence those involved in the field of TB/HIV need to constantly update their knowledge in this field. The purpose of this review is to describe, discuss and summarize current concepts and practices in the diagnosis, treatment and control of HIV associated tuberculosis. Diagnosis of HIV associated tuberculosisTB symptoms: One of the major advances in the clinical diagnosis of TB/HIV has been the demonstration in number of studies that TB/HIV patients with cough should be tested for TB irrespective of the duration of the cough (Kevin et al., 2010), Ngadaya et al., 2009). In a study that evaluated the performance of different combination of TB symptoms, it was found that the best symptom combination included two predictors; fever of any duration in the previous 4 weeks plus cough of a...

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Section: Treatment Shortening and New Att Drugs Studiesmentioning

confidence: 99%

Advances in the Diagnosis, Treatment and Control of HIV Associated Tuberculosis

Kirenga¹,

Chanda²,

Muwonge³

et al. 2012

African Journal of Infectious Diseases

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“…The effect of replacement of EMB with standard dose of MFX or GFX (each at 400 mg) was evaluated in three separate phase II clinical trials in the intensive phase of treatment of sputum smear-positive pulmonary TB patients which yielded variable results. The first of these studies, carried out by the TB Trials Consortium, reported higher rates of sputum culture conversion at 4 and 6 weeks of therapy but not at week 8 in MFX-containing regimen [42]. Another study conducted in Rio de Janeiro, Brazil, also reported higher rates of sputum culture conversion beginning at 2 weeks and persisting till week 8 of therapy in MFXcontaining regimen [43].…”

Section: Fluoroquinolones As Anti-tb Drugsmentioning

confidence: 99%

“…The results of the four phase II trials involving MFX and GFX have shown that replacement of either MFX or GFX with EMB or replacement of MFX with INH is at least as efficacious as the standard intensive phase of therapy and may even contribute towards more rapid clearing of the infected lungs by rapidly dividing tubercle bacilli [42][43][44][45]. Both mFQs are now in two separate phase III clinical trials for the treatment of adult patients newly diagnosed with drug sensitive, pulmonary TB for investigation of whether treatment duration can be effectively shortened to 4 months by substitution of GFX for EMB or MFX for either EMB or INH [49,50].…”

Section: Fluoroquinolones As Anti-tb Drugsmentioning

confidence: 99%

Role of fluoroquinolones in the treatment of tuberculosis

Ahmad

Mokaddas

2011

RHC

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“…Encouragingly, a more potent extended EBA, that is, from days 2 to 7, was observed with the FQs than for INH [47]. A recent Phase II trial to investigate whether MXF could replace EMB in INH plus PZA plus RIF plus EMB combinations revealed that, although the MXF regimes showed more frequent sputum conversion at 4 weeks, the success of the treatments provided identical outcomes after 2 months [49]. The 2-month timepoint coincides with the end of the intensive phase of treatment with common regimens, and culture conversion rates at this stage are a well-accepted surrogate marker for the sterilizing activity of anti-tuberculosis drugs.…”

Section: Quinolonesmentioning

confidence: 99%