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Free Content Early and extended early bactericidal activity of levofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis

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OBJECTIVE: To evaluate the early bactericidal activity (EBA) of the new fluoroquinolones levofloxacin, gatifloxacin and moxifloxacin in patients with pulmonary tuberculosis (PTB).

DESIGN: Randomized, open-label trial. Forty adults with newly diagnosed smear-positive PTB (10 per arm) were assigned to receive isoniazid (INH) 300 mg, levofloxacin 1000 mg, gatifloxacin 400 mg, or moxifloxacin 400 mg daily for 7 days. Sputum for quantitative culture was collected for 2 days before and daily during 7 days of monotherapy. Bactericidal activity was estimated by measuring the decline in bacilli during the first 2 days (EBA 0–2) and last 5 days of monotherapy (extended EBA, EBA 2–7). Laboratory staff were blinded to treatment assignment.

RESULTS: The EBA 0–2 of INH (0.67 log10 cfu/ml/day) was greater than that of moxifloxacin and gatifloxacin (0.33 and 0.35 log10 cfu/ml/day, respectively), but not of levofloxacin 1000 mg daily (0.45 log10 cfu/ml/day) (P = 0.14). Bactericidal activity between days 2 and 7 was similar for all three fluoroquinolones. In a pooled comparison, the EBA 2–7 of the fluoroquinolones was greater than for INH.

CONCLUSION: Moxifloxacin, gatifloxacin, and high-dose levofloxacin have excellent EBA, only slightly less than for INH, and greater extended EBA. These drugs warrant further study in the treatment of drug-susceptible TB.

Keywords: antitubercular agents; early bactericidal activity; fluoroquinolones; gatifloxacin; levofloxacin; moxifloxacin; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio, USA 2: Núcleo de Doenças Infecciosas, Centro Biomédico, Universidade Federal do Espírito Santo, Vitória, Brazil 3: Division of Mycobacterial and Respiratory Infections, National Jewish Medical and Research Center, Denver, Colorado, USA 4: Infectious Disease Pharmacokinetics Laboratory, National Jewish Medical and Research Center, Denver, Colorado, USA; and Schools of Pharmacy and Medicine, University of Colorado, Denver, Colorado, USA 5: University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA 6: Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA 7: AIDS Research Institute, University of California–San Francisco, San Francisco, California, USA

Publication date: June 1, 2006

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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