Fluoroquinolones for treating tuberculosis

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Abstract
Background Fluoroquinolones are sometimes used to treat multiple-drug-resistant and drug-sensitive tuberculosis. The effects of fluoroquinolones in tuberculosis regimens need to be assessed. Objectives To assess fluoroquinolones as additional or substitute components to antituberculous drug regimens for drug-sensitive and drug-resistant tuberculosis. Search strategy We searched the Cochrane Infectious Diseases Group Specialized Register (April 2005), CENTRAL (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to April 2005), EMBASE (1974 to April 2005), LILACS (1982 to April 2005), Science Citation Index (1940 to April 2005), and Russian database (1988 to April 2005). We also scanned reference lists of all identified studies and contacted researchers. Selection criteria Randomized controlled trials of antituberculous regimens containing fluoroquinolones in people diagnosed with bacteriologically positive (sputum smear or culture) pulmonary tuberculosis. Data collection and analysis Two authors independently applied inclusion criteria, assessed methodological quality, and extracted data. We used relative risk (RR) for dichotomous data, weighted mean difference (WMD) for continuous data (both with 95% confidence intervals (CD), and the random- effects model if we detected heterogeneity and appropriate to combine data. Main results Ten trials (1178 participants) met the inclusion criteria. No statistically significant difference was found in trials substituting ciprofloxacin or ofloxacin for first-line drugs in relation to cure ( 89 participants, 2 trials), treatment failure ( 388 participants, 3 trials), or clinical or radiological improvement ( 216 participants, 2 trials). Substituting ciprofloxacin into first-line regimens in drug-sensitive tuberculosis led to a higher incidence of relapse (RR 7.17, 95% CI 1.33 to 38.58; 384 participants, 3 trials) and longer time to sputum culture conversion (WMD 0.50 months, 95% CI 0.18 to 0.82; 168 participants, 1 trial), although this was confined to HIV-positive participants. Adding or substituting levofloxacin to basic regimens in drug-resistant areas had no effect. A comparison of sparfloxacin versus ofloxacin added to regimens showed no statistically significant difference in cure (184 participants, 2 trials), treatment failure (149 participants, 2 trials), or total number of adverse events (253 participants, 3 trials). Authors' conclusions Only ciprofloxacin, ofloxacin, levofloxacin, and sparfloxacin have been tested in randomized controlled trials for treating tuberculosis. We cannot recommend ciprofloxacin in treating tuberculosis. Trials of newer fluoroquinolones for treating tuberculosis are needed. No difference has been demonstrated between sparfloxacin and ofloxacin in drug-resistant tuberculosis.