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Free Content Use of fluoroquinolone antibiotics leads to tuberculosis treatment delay in a South African gold mining community

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Abstract:

BACKGROUND: Empiric use of fluoroquinolone (FQ) antibiotics could delay tuberculosis (TB) treatment and lead to FQ-resistant TB.

METHODS: We examined the impact of FQ use on TB outcomes, including smear status, treatment delay and FQ resistance, through a retrospective cohort study of 440 FQ-exposed and 511 non-exposed patients in a gold mining community in South Africa. We considered both recent (≤100 days before sputum collection) and distant exposure (≤1 year). We examined 201 and 180 isolates from FQ-exposed and non-exposed individuals for the presence of gyrA mutations.

RESULTS: Patients recently exposed to ≥5 days of FQ were less likely to be smear-positive (OR 0.27, 95%CI 0.11–0.63), with an increased time to treatment (time ratio 2.02, 95%CI 1.19–3.44). The strength of association decreased when we considered distant exposure. Adjusting for smear status nullified the effect of FQ exposure on treatment delay. We detected a gyrA mutation in one isolate (0.5%) taken from an individual exposed to FQ for 8 days.

CONCLUSION: FQ exposure is associated with treatment delay, mediated by negative smear status. Short exposures to FQ do not routinely lead to resistance encoded by gyrA mutations. We recommend prudent use of FQ in settings with a high burden of human immunodeficiency virus and TB.

Keywords: drug-resistant TB; fluoroquinolone; smear microscopy; treatment delay; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA 2: Anglogold Ashanti Health West Vaal Hospital, Orkney, North West, South Africa 3: Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa 4: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA 5: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Publication date: January 1, 2011

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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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