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      Indications and safety profile of fluoroquinolones in the treatment of tuberculosis in a general hospital of the Autonomous City of Buenos Aires

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          Abstract

          Introduction: Fluoroquinolones are frequently used in treatment regimes for tuberculosis both in cases of multidrug-resistant tuberculosis, where they are an essential part of the regime, and also in cases of drug-sensitive tuberculosis with intolerance to first-line drugs. Objectives: To evaluate indications to include fluoroquinolones in the anti-tuberculosis treatment and to describe the adverse events associated with their use. Materials and Methods: A retrospective analysis of the patients who began treatment for tuberculosis between January 1, 2014 and December 31, 2016 was performed. We defined an adverse event as the condition that resulted in the suspension of a drug or the need to use specific drugs for its management. Group characteristics were compared by using the c2 test. Results: Of the 267 patients who began treatment in said period, 24 (11 men) received fluoroquinolones, representing 9% of the total population; 19 were treated with 400 mg/day of moxifloxacin and the rest with 750 mg/day of levofloxacin. In the comparison of the groups receiving fluoroquinolones versus the ones without fluoroquinolones, there were no significant differences in the percentage of male participants (46 vs. 58%), age (34.7 ± 12 vs. 35.1 ± 15 years), pulmonary involvement (58 vs. 68%) and withdrawal rate (26 vs. 21%). There was a higher proportion of Argentinians (71 vs. 44%, p = 0.012) and of HIV-positive individuals (46 vs. 8.6%) p < 0.05) in the group with fluoroquinolones vs. the group without fluoroquinolones. Fluoroquinolones were indicated in replacement of rifampicin in 9 patients (37.5%) due to its interaction with antiretroviral drugs, in 9 patients (37.5%) due to intolerance, and in 5 patients (21%) due to resistance to first-line anti-tuberculosis drugs. In one individual, fluoroquinolones were indicated instead of pyrazinamide due to history of cirrhosis. The time of treatment with fluoroquinolones was 203 ± 158 days (range 30-660) with no observed adverse events related to their use. Conclusion: In the group under study, the use of fluoroquinolones was not associated with adverse events. The most frequent indications in these patients were drug interactions in HIV-positive patients and intolerance to first-line drugs.

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          Most cited references 8

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          Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.

          The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.
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            Fluoroquinolones for treating tuberculosis (presumed drug-sensitive).

             Lilia E Ziganshina (corresponding) ,  Albina Titarenko,  Geraint Davies (2013)
            Currently the World Health Organization only recommend fluoroquinolones for people with presumed drug-sensitive tuberculosis (TB) who cannot take standard first-line drugs. However, use of fluoroquinolones could shorten the length of treatment and improve other outcomes in these people. This review summarises the effects of fluoroquinolones in first-line regimens in people with presumed drug-sensitive TB.
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              Consenso Argentino de Tuberculosis

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ramer
                Revista americana de medicina respiratoria
                Rev. am. med. respir.
                Asociación Argentina de Medicina Respiratoria (CABA, , Argentina )
                1852-236X
                June 2018
                : 18
                : 2
                : 116-120
                Affiliations
                CABA orgnameHospital General de Agudos Parmenio P. Piñero Argentina
                Article
                S1852-236X2018000200007

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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