J Korean Med Sci.  2013 Mar;28(3):378-382. 10.3346/jkms.2013.28.3.378.

Clinical Effects of Gemifloxacin on the Delay of Tuberculosis Treatment

• Kim SY
• Yim JJ
• Park JS
• Park SS
• Heo EY
• Lee CH
• Chung HS
• Kim DK

• KMID: 1786934
• DOI: http://doi.org/10.3346/jkms.2013.28.3.378

Abstract

Although gemifloxacin has low in vitro activity against Mycobacterium tuberculosis, the effect of gemifloxacin on the delay of tuberculosis (TB) treatment has not been validated in a clinical setting. The study group included patients with culture-confirmed pulmonary TB who initially received gemifloxacin for suspected community-acquired pneumonia (CAP). Two control groups contained patients treated with other fluoroquinolones or nonfluoroquinolone antibiotics. Sixteen cases were treated with gemifloxacin for suspected CAP before TB diagnosis. Sixteen and 32 patients were treated with other fluoroquinolones and nonfluoroquinolones, respectively. The median period from the initiation of antibiotics to the administration of anti-TB medication was nine days in the gemifloxacin group, which was significantly different from the other fluoroquinolones group (35 days). The median times for the nonfluoroquinolone group and the gemifloxacin group were not significantly different. There were no significant differences between the gemifloxacin and other fluoroquinolone group in terms of symptomatic and radiographic improvements. However, the frequency of radiographic improvement in the other fluoroquinolones group tended to be higher than in the gemifloxacin group. Gemifloxacin might be the preferred fluoroquinolone for treating CAP, to alleviate any concerns about delaying TB treatment.

Keyword

Fluoroquinolones; Tuberculosis; Pneumonia

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/*therapeutic use
Case-Control Studies
Fluoroquinolones/*therapeutic use
Humans
Middle Aged
Naphthyridines/*therapeutic use
Pneumonia/complications/diagnosis
Tuberculosis/complications/*drug therapy/radiography
Anti-Bacterial Agents
Fluoroquinolones
Naphthyridines

Figure

• 

  Fig. 1 The time interval from the initiation of antibiotics until the administration of anti-TB drugs. The median time intervals from the initiation of antibiotics until the administration of anti-TB medications were nine days (range, 7-72 days) in the gemifloxacin group, 35 days in the other fluoroquinolones group (range, 14-72 days) and 7 days in the nonfluoroquinolone group (range, 3-63 days). *P value < 0.05.

• 

  Fig. 2 Differences in the proportions of patients with symptomatic improvements. Symptomatic improvement was defined when more than one symptom of the followings was improved: febrile sense, cough, dyspnea, general weakness and pleuritic chest pain. The proportions of subjects with symptomatic improvements were 50% in the gemifloxacin group and the other fluoroquinolones group and 31% in the nonfluoroquinolone group.

• 

  Fig. 3 Differences in the proportions of patients with radiographic improvement. Radiographic improvement was defined when radiograhic improvement was detected on a follow-up chest radiograph within 1-4 weeks after antibiotic treatment. Seven patients (44%) in the other fluoroquinolones group had improved follow-up radiographs, while four patients (25%) had improvements in the gemifloxacin group. Radiographic improvement was observed in only 12% of patients treated with nonfluoroquinolone antibiotics. *P value < 0.05.

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