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.
Highlights
Pulmonary tuberculosis (TB) is a contagious disease in which the human lung is primarily infected by a pathogen, Mycobacterium tuberculosis
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)
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
Summary
Pulmonary tuberculosis (TB) is a contagious disease in which the human lung is primarily infected by a pathogen, Mycobacterium tuberculosis. It is estimated that about 37 million patients were saved through appropriate treatment such as the standard regimen of isoniazid (H), rifampin (R), ethambutol (E), and pyrazinamide (Z) (HREZ) with a successful treatment rate as high as from 86–95% [1,2]. Adherence to the treatment for drug-sensitive pulmonary TB is one of the most important factors for maximizing the efficacy of TB treatment and minimizing the occurrence of multiple drug resistance [3]. Patients’ poor adherence to anti-TB therapy contributes to treatment failure, relapse, or death by pulmonary TB [4,5]. Numerous efforts have been made to improve the tolerance of patients to anti-TB medication by decreasing the treatment duration [6,7]. The present study was conducted to validate the fluoroquinolone-containing regimen for drug-sensitive pulmonary tuberculosis
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