Fluoroquinolone Therapy for the Prevention of Multidrug-Resistant Tuberculosis in Contacts. A Cost-Effectiveness Analysis

Am J Respir Crit Care Med. 2015 Jul 15;192(2):229-37. doi: 10.1164/rccm.201501-0069OC.


Rationale: Fluoroquinolone (FQN) therapy of latent tuberculosis infection among contacts of individuals with multidrug-resistant tuberculosis (MDR-TB) is controversial.

Objectives: To determine the potential benefits, risks (including acquired FQN resistance), and cost-effectiveness of FQN therapy to prevent TB in contacts of individuals with MDR-TB.

Methods: We used decision analysis to estimate costs and outcomes associated with no therapy compared with a 6-month course of daily FQN therapy to treat latent TB infection in contacts of individuals with MDR-TB. Outcomes modeled were the incidence of MDR-TB, MDR-TB with FQN resistance, TB-related death, quality-adjusted life years, and health system costs.

Measurements and main results: FQN preventive therapy resulted in health system savings, lower incidence of MDR-TB, and lower mortality than no treatment. We found the incidence of MDR-TB with acquired FQN resistance would also be lower with FQN therapy of infected contacts.

Conclusions: In our model, FQN preventive therapy resulted in substantial health system savings and in reduced mortality, incidence of MDR-TB, and incidence of acquired FQN-resistant disease as well as improved quality of life. FQN therapy remained cost saving with improved outcomes even if the effectiveness of therapy in preventing MDR-TB was as low as 10%.

Keywords: antitubercular agents; cost-effectiveness analysis; latent tuberculosis infection; multidrug-resistant tuberculosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use*
  • Cost-Benefit Analysis / statistics & numerical data*
  • Female
  • Fluoroquinolones / economics*
  • Fluoroquinolones / therapeutic use*
  • Humans
  • Male
  • Models, Economic
  • Tuberculosis, Multidrug-Resistant / drug therapy*


  • Anti-Bacterial Agents
  • Fluoroquinolones