NEW ORLEANS, LA—The use of fluoroquinolones in patients with respiratory infections was found to delay the diagnosis of active pulmonary tuberculosis, according to a study presented at IDWeek 2016. 

Fluoroquinolones, some of the most commonly used antibiotics for respiratory infections, demonstrate bactericidal activity against Mycobacterium tuberculosis complex. Because of this, there is concern that its use may contribute to a delayed diagnosis of tuberculosis. The current International Standards for TB Care recommends against the use of fluoroquinolones in adults with suspected tuberculosis but these recommendations may not be followed consistently. Catherine Hogan, MDCM, MSc, from McGill University, Montreal, QC, Canada, and colleagues conducted a systematic review to determine whether empiric fluoroquinolone use delayed the diagnosis and treatment of tuberculosis in patients with respiratory tract infections.

The review’s primary objective was to assess the delays in tuberculosis diagnosis and treatment in patients who received fluoroquinolones vs. patients who did not receive fluoroquinolones. A literature search within 7 databases returned a total of 3,983 citations.

Seventeen articles were included for full review, of which 10 were retained for the narrative synthesis (n=18,179). The authors noted 1 of the 10 studies was from South Africa, a high tuberculosis burden country. The systematic review showed that the most commonly used fluoroquinolones were levofloxacin, gemifloxacin, moxifloxacin, and ciprofloxacin. There was a median delay in time of presentation to time of anti-tuberculosis therapy initiation by 12.93 days (95% CI: 6.13–19.73) in the fluoroquinolone group vs. the non-fluoroquinolone group. The delay was consistently longer in the smear-negative group when stratified by acid-fast smear status. A previous systematic review and meta-analysis published in 2011 had reported a diagnostic delay of 19.03 days (95% CI: 10.87–27.18). 

“Based on one study, there was a suggestion of a proportional increase in the diagnostic delay based on the duration of fluoroquinolone exposure,” added Hogan. Specifically, there was a delay of 18.3 days in the 1-day exposure group compared to 23.1 days in the ≥5-days exposure group.  

The findings suggest that the use of these antibiotics should be avoided when tuberculosis is suspected, which is consistent with the International Standards for TB Care.