Fluoroquinolones are among the most commonly used antibiotics for the treatment of respiratory infections. Because quinolones show bactericidal activity against Mycobacterium tuberculosis complex, there is concern that their use can delay the diagnosis of tuberculosis. We conducted a systematic review to assess whether empiric treatment with fluoroquinolones delays the diagnosis and treatment of tuberculosis in patients with respiratory tract infections.
The primary objective was to assess the delay in days in the diagnosis and treatment of tuberculosis, among patients who received quinolones, compared to those who did not. We included studies of adult patients treated with fluoroquinolones prior to a confirmed diagnosis of tuberculosis. We performed a literature search of 7 databases (including PubMed, Embase and Cochrane Library) with no language restrictions. We excluded case series of less than 10 patients, as well as articles for which either the full text or information on diagnostic delay was not available. A meta-analysis was not conducted because of variations in comparison groups and study methodologies.
A total of 2261 citations were identified from the literature search; of these, 15 articles were selected for full-text review. A total of 8 studies were retained for the narrative synthesis. These included 5 retrospective cohort studies and 3 case-control studies. 1 of the 8 studies was from a high TB burden country. The most commonly used fluoroquinolones were levofloxacin, gemifloxacin, moxifloxacin and ciprofloxacin. The median delay in time of presentation to time of diagnosis of tuberculosis was 22.5 days (IQR 13.5-26.2) in the fluoroquinolone group compared to the non-fluoroquinolone group. When stratified by acid-fast smear status, the delay was consistently greater in the smear-negative group. Based on one study, there was suggestion of a proportional increase in the diagnostic delay based on the duration of fluoroquinolone exposure.
The use of fluoroquinolones in patients with respiratory infections delays the diagnosis of active pulmonary tuberculosis. Consistent with the International Standards for TB Care, their use should be avoided when tuberculosis is suspected.
G. Gore, None
M. Pai, None