Community-acquired pneumonia and tuberculosis: differential diagnosis and the use of fluoroquinolones

Int J Infect Dis. 2014 Jan;18:14-21. doi: 10.1016/j.ijid.2013.09.013. Epub 2013 Oct 26.


The respiratory fluoroquinolones moxifloxacin, gemifloxacin, and high-dose levofloxacin are recommended in guidelines for effective empirical antimicrobial therapy of community-acquired pneumonia (CAP). The use of these antibiotics for this indication in areas with a high prevalence of tuberculosis (TB) has been questioned due to the perception that they contribute both to delays in the diagnosis of pulmonary TB and to the emergence of fluoroquinolone-resistant strains of Mycobacterium tuberculosis. In this review, we consider some of the important questions regarding the potential use of fluoroquinolones for the treatment of CAP where the burden of TB is high. The evidence suggests that the use of fluoroquinolones as recommended for 5-10 days as empirical treatment for CAP, according to current clinical management guidelines, is appropriate even in TB-endemic regions. It is critical to quickly exclude M. tuberculosis as a cause of CAP using the most rapid relevant diagnostic investigations in the management of all patients with CAP.

Keywords: Differential diagnosis; Fluoroquinolone; Mycobacterium tuberculosis; Pneumonia; Resistance; Tuberculosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Community-Acquired Infections / diagnosis*
  • Community-Acquired Infections / drug therapy
  • Diagnosis, Differential
  • Dose-Response Relationship, Drug
  • Fluoroquinolones / therapeutic use
  • Humans
  • Mycobacterium tuberculosis / drug effects
  • Pneumonia / diagnosis*
  • Pneumonia / drug therapy
  • Prevalence
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy


  • Anti-Bacterial Agents
  • Fluoroquinolones