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Free Content Fluoroquinolone exposure prior to tuberculosis diagnosis is associated with an increased risk of death

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SETTING: Fluoroquinolone (FQ) exposure before tuberculosis (TB) diagnosis is common, but its effect on outcomes, including mortality, is unclear.

DESIGN: Among TB patients reported to the Tennessee Department of Health from 2007 to 2009, we assessed FQ exposure within 6 months before TB diagnosis. The primary outcome was the combined endpoint of death at the time of TB diagnosis and during anti-tuberculosis treatment.

RESULTS: Among 609 TB cases, 214 (35%) received FQs within 6 months before TB diagnosis. A total of 71 (12%) persons died; 10 (2%) were dead at TB diagnosis and 61 (10%) died during anti-tuberculosis treatment. In multivariable logistic regression analysis, factors independently associated with death were older age (OR 1.05 per year, 95%CI 1.04–1.07), human immunodeficiency virus infection (OR 8.08, 95%CI 3.83–17.06), US birth (OR 3.03, 95%CI 1.03–9.09), and any FQ exposure before TB diagnosis (OR 1.82, 95%CI 1.05–3.15). Persons with FQ exposure before TB diagnosis were more likely to have culture- and smear-positive disease than unexposed persons.

CONCLUSIONS: Among this patient population, FQ exposure before TB diagnosis was associated with an increased risk of death. These findings underscore the need for cautious use of FQs in persons with possible TB.
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Keywords: drug resistance; drug-susceptible TB; mortality

Document Type: Research Article

Affiliations: 1: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Tennessee Department of Health, Nashville, Tennessee, USA 3: Tennessee Department of Health, Nashville, Tennessee, USA 4: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 5: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Publication date: 01 September 2012

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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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