The Rapid Development of Fluoroquinolone Resistance inM. tuberculosis

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Abstract
The development of resistance in Mycobacterium tuberculosis after empirical monotherapy could limit the role of fluoroquinolones in the treatment of tuberculosis. A 36-year-old man with AIDS (CD4+ lymphocyte count, 40 per cubic millimeter) presented with weight loss, flank pain, fevers, and dysuria. Examination revealed prostatic nodules, and computed tomography revealed abscesses. He received six days of levofloxacin therapy for prostatitis; ethambutol and clarithromycin were added for possible M. avium complex infection. There was no clinical improvement. He then received ciprofloxacin alone for seven days and afterward underwent transurethral prostatic resection; acid-fast smears were positive. A urine culture obtained four days before the initiation of levofloxacin therapy grew M. tuberculosis (isolate 1). A culture of a prostatic abscess subsequently also grew M. tuberculosis (isolate 2).