Fluoroquinolones for treating tuberculosis (presumed drug-sensitive)

Substituting or adding fluoroquinolones to established first-line antituberculous drug regimens gives no additional benefit or risks

Lilia E Ziganshina1,*, Albina F Titarenko1, Geraint R Davies2

Kazan (Volga region) Federal University, Department of Basic and Clinical Pharmacology, Kazan, Tatarstan, Russian Federation
University of Liverpool, Institute of Infection and Global Health, Liverpool, Merseyside, UK

Fluoroquinolones for treating tuberculosis (presumed drug-sensitive). Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004795. 

To read the full review please follow this link: DOI: 10.1002/14651858.CD004795.pub4.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis bacteria. Over two billion people worldwide are believed to be latently infected with TB and approximately 10% of these people will develop active TB later in life. The World Health Organization currently only recommend treatment with fluoroquinolones for patients who cannot take standard first-line drugs. In this review, we examined the effect of including fluoroquinolones in first-line treatment regimens on people with presumed drug-sensitive tuberculosis.

We examined the research published up to 6 March 2013 and we identified five randomised controlled trials (1330 people) that met the inclusion criteria. The trials were performed in low- and middle-income countries located in geographically diverse areas but there was a lack of studies conducted in Asia. We found no studies that examined the effect of including fluoroquinolones in a standard six month TB treatment regimen on treatment failure. We do not know whether adding fluoroquinolones or substituting fluoroquinolones for ethambutol in a standard six month TB treatment regimen reduces treatment failure, relapse, death, or adverse events. Substituting fluoroquinolones for isoniazid in a standard six month TB treatment regimen may have little or no difference upon death and adverse events. Currently, there are nine randomised controlled trials ongoing.

HIV-positive participants were relatively well-represented in the included trials but none of the included trials stratified outcomes by HIV status. Also, the primary outcomes of all the included trials were reached before initiation of antiretroviral treatment. Evidence is generally lacking on the safety and efficacy of fluoroquinolone additions or substitutions in children (< 18 years) and in pregnant and lactating women.