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Open Access Gatifloxacin is superior to levofloxacin and moxifloxacin in shorter treatment regimens for multidrug-resistant TB

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SETTING: Data were collected from patients starting one of the shorter treatment regimens (STRs) for multidrug-resistant tuberculosis (MDR-TB) in Bangladesh, Niger or Cameroon.

OBJECTIVE: To estimate the effect of either a gatifloxacin (GFX), moxifloxacin (MFX) or levofloxacin (LVX) based STR on bacteriological effectiveness.

DESIGN: Retrospective study of prospectively collected data.

RESULTS: Among 1530 patients, bacteriological effectiveness was 96.7% overall. Stratified by treatment with a GFX-, LVX- or MFX-based regimen effectiveness was respectively 97.5%, 95.5% and 94.7%. Compared to those on a GFX-based regimen, the estimated summary odds ratio of having an adverse outcome was more than double (OR 2.05, 95% CI 1.09–3.90) in patients treated with either an LVX-based or MFX-based regimen. After adjusting for initial resistance, patients treated with an LVX-based regimen and MFX-based regimen had respectively a 4.5- and 8.4-fold times larger odds of an adverse bacteriological outcome. None among 859 patients at risk treated with a GFX-based compared to at least 4 of 228 among those on an MFX-based regimen acquired fluoroquinolone resistance.

CONCLUSION: GFX-based regimens had superior bacteriological effectiveness than MFX-based or LVX-based regimens. As GFX is currently unavailable in most MDR-TB programs, its reintroduction should be prioritised.
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Keywords: bacteriological effectiveness; core drug; gatifloxacin; levofloxacin; moxifloxacin

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp 2: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Research Foundation Flanders, Brussels, Belgium 3: Faculty of Health Sciences, University of Bamenda, Bamenda 4: Independent Consultant, Douala, Cameroon 5: International Union Against Tuberculosis and Lung Disease, Paris, France, Damien Foundation, Brussels, Belgium 6: Damien Foundation Bangladesh, Dhaka, Bangladesh 7: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Tuberculosis Consultant Services, Kirchlindach, Switzerland

Publication date: September 1, 2019

More about this publication?
  • 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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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