Quinolones for mycobacterial infections

Rubinstein, Ethan; Keynan, Yoav

doi:10.1016/j.ijantimicag.2013.03.005

Cited by 7 publications

(5 citation statements)

References 36 publications

(45 reference statements)

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“…Ciprofloxacin (CIP) and ofloxacin (OFX) is at least effective against TB bacilli, levofloxacin (LEV), gatifloxacin (GTX), moxifloxacin (MXF), and sparfloxacin (SPX), which is reported as the most effective FQs. It is also stated that powerful FQs such as MXF and LEV may be considered as first-line drugs to shorten the duration of treatment in susceptible cases (6,(9)(10)(11)(12). FQs exhibit bactericidal effects against M. tuberculosis via the DNA gyrase enzyme, a Type II topoisomerase encoded by gyrA and gyrB genes.…”

Section: Introductionmentioning

confidence: 99%

“…FQs exhibit bactericidal effects against M. tuberculosis via the DNA gyrase enzyme, a Type II topoisomerase encoded by gyrA and gyrB genes. FQ resistance in M. tuberculosis has been observed to be a consequence of the presence of mutations, low cell wall permeability, and efflux pump systems in or around the "quinolone resistance determining region (QRDR)" on gyrA/gyrB in general (6,(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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In vitro effects of ciprofloxacin, levofloxacin and moxifloxacin on Mycobacterium tuberculosis isolates

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vitro effects of ciprofloxacin, levofloxacin and moxifloxacin on Mycobacterium tuberculosis isolates

et al. 2018

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“…Furthermore, the use of FQs for initial tuberculosis therapy raises concerns regarding whether the application of FQs in drug-sensitive TB will increase the rate of FQ-resistant M. tuberculosis isolates, thereby hampering the treatment of multi-drug resistant TB (MDR-TB) in more difficult situations. FQs currently play a very important role in the treatment of MDR-TB 18 , 36 and are strongly recommended by the WHO guidelines for the programmatic management of drug-resistant tuberculosis. 1 , 37 They are significantly associated with cure—an effect that is more pronounced for later-generation FQs, such as levofloxacin, MOX and GAT.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews have indicated that insufficient evidence was available to assess the efficacy and safety of MOX or GAT in the first-line regimen for primary pulmonary TB and that much larger trials were required. 17 , 18 A recent meta-analysis concerning the efficacy and safety of MOX plus first-line therapy failed to include relevant newly published randomized clinical trials (RCTs) and did not evaluate the relapse rates of these regimens. 19 Given the inferiority of four-month FQ-containing regimens compared with the six-month standard regimen for drug-susceptible TB in recent large-scale trials, 20 , 21 , 22 we speculate whether these FQ-containing regimens have sufficient anti-TB efficacy in vivo .…”

Section: Introductionmentioning

confidence: 99%

Moxifloxacin and gatifloxacin for initial therapy of tuberculosis: a meta-analysis of randomized clinical trials

Ruan

Liu

Sun

et al. 2016

Emerging Microbes & Infections

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Moxifloxacin (MOX) and gatifloxacin (GAT) have exhibited promising mycobactericidal activity, and a number of clinical trials have been conducted in recent decades to compare the treatment efficacy of MOX-containing and/or GAT-containing regimens with the standard regimen. The aim of this meta-analysis for clinical trials of MOX- or GAT-containing regimens was to evaluate their treatment efficacy and safety in initial therapy for drug-sensitive tuberculosis (TB). Databases were searched for randomized controlled trials, and nine studies with 6980 patients were included. We found that fluoroquinolone substitution for isoniazid or ethambutol in short-course regimens might result in more frequent unfavorable treatment outcomes compared with the standard regimen—in particular, an increased incidence of relapse. In a per-protocol analysis, MOX-containing regimens had slightly higher rates of sputum culture conversion at two months than the standard regimen (RR 1.08, 95% CI 1.04–1.11, P <0.001); there was no significant difference in the rate of sputum conversion between the GAT-containing regimens and the standard regimen (RR 1.13, 95% CI 0.96–1.33, P = 0.13). There were no significant differences in the incidence of death from any cause, including TB, nor were there serious adverse events between the MOX- or GAT-containing regimens and the standard regimen. In conclusion, MOX or GAT might not have the ability to shorten treatment duration in the initial therapy for tuberculosis despite the non-inferiority or even slightly better efficacy in the early phase of treatment compared with the standard regimen. Furthermore, it is safe to include MOX or GAT in initial TB treatment.

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“…Recognized 'second-line' agents include ethionamide (ETH) or prothionamide, kanamycin (KM) or amikacin (AMK), terizidone/ cycloserine (CS), capreomycin (CAP), viomycin and para-aminosalicylic acid (PAS) (Lienhardt et al, 2010). Without any formal evaluation, fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) have also attained a prominent position in regimens for the treatment of drug resistant tuberculosis; clinical studies are undergoing and may lead to their inclusion in 'first-line' regimens (Rubinstein and Keynan, 2013). Structures, targets and mechanisms of action of current TB drugs are summarized in Table 2.…”

Section: Current Anti-tuberculosis Chemotherapymentioning

confidence: 99%