Seifert M, et al. – Authors sought to assess the impact of fluoroquinolone use on mortality among a cohort of patients with suspected drug–resistant tuberculosis. Observations revealed a marked reduction patient mortality risk with use of later–generation fluoroquinolones, this, in turn, suggested that removal of a later–generation fluoroquinolone from a treatment regimen because of demonstrated resistance to an earlier–generation fluoroquinolone could increase mortality risk. They recommend further studies to evaluate the effectiveness of later–generation fluoroquinolones among patients with and without resistance to early–generation fluoroquinolones.

Methods

• As part of a comparative diagnostic study, authors performed a prospective cohort study with 834 Mycobacterium tuberculosis–infected patients from selected hospitals and clinics with high prevalence of drug–resistant tuberculosis (TB) in India, Moldova, and South Africa.
• Cox proportional hazards regression models were used to assess the association between later–generation fluoroquinolone (moxifloxacin or levofloxacin) use and patient mortality, adjusting for risk factors typically associated with poor treatment outcomes.

Results

• After adjusting for phenotypic resistance profile, low body mass index (<18.5 kg/m²), human immunodeficiency virus status, and study site, it was observed that participants receiving a later–generation fluoroquinolone had half the risk of mortality compared with participants either not received any fluoroquinolone or receiving only an earlier–generation fluoroquinolone (adjusted hazard ratio, 0.46 [95% confidence interval, .26–.80]) during follow–up.