The Effectiveness and Safety of Fluoroquinolone-Containing Regimen as a First-Line Treatment for Drug-Sensitive Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

Abstract

BackgroundFluoroquinolone is recommended as a pivotal antituberculous agent for treating multi-drug-resistant pulmonary tuberculosis. However, its effectiveness as first-line treatment remains controversial. The present study was conducted to validate the fluoroquinolone-containing regimen for drug-sensitive pulmonary tuberculosis.MethodsWe searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials until June 5, 2015. Randomized controlled trials (RCTs) that compared antituberculous regimens containing fluoroquinolone with the standard regimen were included.ResultsEleven RCTs that included 6,334 patients were selected. Fluoroquinolone-containing regimens had a higher rate of sputum culture conversion at 2 months of treatment (M-H fixed odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20–1.54). However, the outcomes were less favorable (M-H fixed OR, 0.69; 95% CI, 0.59–0.82) and the associated total adverse events were more frequent (M-H fixed OR, 1.84; 95% CI, 1.46–2.31) in the fluoroquinolone-containing regimen group, without a significant heterogeneity according to treatment duration. Treatment with the fluoroquinolone-containing regimen for 4 months showed a higher relapse rate.ConclusionsDespite a higher culture conversion rate at 2 months of treatment, the fluoroquinolone-containing regimen had limitations, including less favorable outcomes and more adverse events, as the first-line therapy for drug-sensitive pulmonary tuberculosis.

Impact of renal function-based anti-tuberculosis drug dosage adjustment on efficacy and safety outcomes in pulmonary tuberculosis complicated with chronic kidney disease

“…Drug-related side effects sometimes require the permanent discontinuation of an initial drug and thus a change of regimen to an alternative second-line drug such as fluoroquinolone. However, as regimens containing fluoroquinolone result in poorer outcomes and more frequent side effects [34], regimen changes should be strongly avoided. In the present study, severe CKD was a significant risk factor for regimen change in the CKD patients, with respective rates of 33.3% in the severe CKD group versus 3.4% in the non-CKD group, as were drug-induced hepatitis and cutaneous reactions.…”

Impact of Fluoroquinolone Use on Mortality Among a Cohort of Patients With Suspected Drug-Resistant Tuberculosis

“…In addition, among drug-resistant TB patients, increased risk of mortality has been attributed to the limited number of potentially effective drugs for patients with resistant strains of Mycobacterium tuberculosis (Mtb) [12]. The repurposing of fluoroquinolones typically reserved for treating drug-resistant TB for use in newer shorter-course treatments for drug-susceptible TB adds further complexity to treatment options for drug-resistant TB [13,14].…”

Incidence, treatment, and outcomes of isoniazid mono-resistant Mycobacterium tuberculosis infections in Alberta, Canada from 2007-2017

“…Of particular mention is empiric use of fluoroquinolones in community-acquired pneumonia, where TB has not been excluded. Additionally, there is a growing understanding of the potential risks fluoroquinolones may pose in addition to long-quoted risk of tendinopathies, including dysglycemia, QTc prolongation, CNS toxicity, neuropathies, aortic aneurysm rupture, and valvular insufficiency [34][35][36].…”