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

• Published in: The international journal of tuberculosis and lung disease Vol. 10; no. 6; pp. 605 - 612
• Main Authors: JOHNSON, J. L, HADAD, D. J, PALACI, M, DIETZE, R, BOOM, W. H, DALEY, C. L, PELOQUIN, C. A, EISENACH, K. D, JANKUS, D. D, DEBANNE, S. M, CHARLEBOIS, E. D, MACIEL, E
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-06-2006; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antitubercular Agents; Aza Compounds - therapeutic use; Biological and medical sciences; Early Bactericidal Activity; Female; Fluoroquinolones; Fluoroquinolones - therapeutic use; Gatifloxacin; Humans; Levofloxacin; Male; Medical sciences; Middle Aged; Miscellaneous; Moxifloxacin; Ofloxacin - therapeutic use; Pharmacology. Drug treatments; Pneumology; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quinolines - therapeutic use; Single-Blind Method; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Human; Lung disease; Levofloxacin; Respiratory disease; Pulmonary tuberculosis; tuberculosis; Mycobacterial infection; Moxifloxacin; Biological activity; Infection; Chemotherapy; Fluoroquinolone derivatives; Treatment; Gatifloxacin; early bactericidal activity; Bacteriosis; Antituberculous agent; antitubercular agents; fluoroquinolones; Antibacterial agent; Quinolone derivatives; Pneumology
• ISSN: 1027-3719; 1815-7920

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.