Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 11 (7), e0159827
eCollection

The Effectiveness and Safety of Fluoroquinolone-Containing Regimen as a First-Line Treatment for Drug-Sensitive Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

Affiliations
Review

The Effectiveness and Safety of Fluoroquinolone-Containing Regimen as a First-Line Treatment for Drug-Sensitive Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

Hyun Woo Lee et al. PLoS One.

Abstract

Background: Fluoroquinolone is recommended as a pivotal antituberculous agent for treating multi-drug-resistant pulmonary tuberculosis. However, its effectiveness as first-line treatment remains controversial. The present study was conducted to validate the fluoroquinolone-containing regimen for drug-sensitive pulmonary tuberculosis.

Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials until June 5, 2015. Randomized controlled trials (RCTs) that compared antituberculous regimens containing fluoroquinolone with the standard regimen were included.

Results: Eleven RCTs that included 6,334 patients were selected. Fluoroquinolone-containing regimens had a higher rate of sputum culture conversion at 2 months of treatment (M-H fixed odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20-1.54). However, the outcomes were less favorable (M-H fixed OR, 0.69; 95% CI, 0.59-0.82) and the associated total adverse events were more frequent (M-H fixed OR, 1.84; 95% CI, 1.46-2.31) in the fluoroquinolone-containing regimen group, without a significant heterogeneity according to treatment duration. Treatment with the fluoroquinolone-containing regimen for 4 months showed a higher relapse rate.

Conclusions: Despite a higher culture conversion rate at 2 months of treatment, the fluoroquinolone-containing regimen had limitations, including less favorable outcomes and more adverse events, as the first-line therapy for drug-sensitive pulmonary tuberculosis.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow chart for the meta-analysis.
Fig 2
Fig 2. Sputum culture conversion rates at 2 months of treatment.
H = isoniazid; R = rifampicin; E = ethambutol; Z = pyrazinamide.
Fig 3
Fig 3. Relapse.
H = isoniazid; R = rifampicin; E = ethambutol; Z = pyrazinamide.
Fig 4
Fig 4. Total favorable outcomes.
H = isoniazid; R = rifampicin; E = ethambutol; Z = pyrazinamide.
Fig 5
Fig 5. Total adverse events.
H = isoniazid; R = rifampicin; E = ethambutol; Z = pyrazinamide.

Similar articles

See all similar articles

Cited by 4 PubMed Central articles

References

    1. Organization WH (2014) Global tuberculosis control: WHO report 2014. Geneva: World Health Organization.
    1. Combs DL, O'Brien RJ, Geiter LJ (1990) USPHS Tuberculosis Short-Course Chemotherapy Trial 21: effectiveness, toxicity, and acceptability. The report of final results. Ann Intern Med 112: 397–406. - PubMed
    1. Chaulk CP, Kazandjian VA (1998) Directly observed therapy for treatment completion of pulmonary tuberculosis: Consensus Statement of the Public Health Tuberculosis Guidelines Panel. Jama 279: 943–948. - PubMed
    1. Cuneo WD, Snider DE Jr. (1989) Enhancing patient compliance with tuberculosis therapy. Clin Chest Med 10: 375–380. - PubMed
    1. Karumbi J, Garner P (2015) Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 5: Cd003343 10.1002/14651858.CD003343.pub4 - DOI - PMC - PubMed

MeSH terms

Grant support

This study was funded by SNUH Research Fund (grant no. 23-2015-0040) (website: http://snuh.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Feedback