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INFECTION: Fawziah Marra, Carlo A. Marra, Susanne Moadebi, Peilin Shi, R. Kevin Elwood, Greg Stark, and J. Mark FitzGerald Levofloxacin Treatment of Active Tuberculosis and the Risk of Adverse Events Chest 2005; 128: 1406-1413 [Abstract] [Full text] [PDF]

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Good tolerance of levofloxacin in treatment of tuberculosis

Kwok C Chang, Chi C. Leung, Chi H. Chau, Wing W. Yew, and Cheuk M. Tam   (3 January 2006)

Good tolerance of levofloxacin in treatment of tuberculosis 3 January 2006
Kwok C Chang, Chest physician Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, CHINA, Chi C. Leung, Chi H. Chau, Wing W. Yew, and Cheuk M. Tam Send letter to journal: Re: Good tolerance of levofloxacin in treatment of tuberculosis ymtcc{at}dh.gov.hk Kwok C Chang, et al.	We read with great interest the population-based, case-control study by Marra F et al[1], which demonstrated that regimens substituting levofloxacin for some standard anti-tuberculosis drugs had significantly lower risk of major adverse events than regimens comprising only standard drugs[1]. They showed in a Poisson regression model that the age- and sex- adjusted rate ratios for any major adverse events and skin major events were 0.60 [95% confidence interval (CI) 0.44–0.82] and 0.43 [95% CI 0.20–0.92] respectively[1]. However, additional adjustment for concomitant standard drugs nullified the rate difference between cases and controls. While the authors should be applauded for their careful observation, they might have overlooked the actual implications of nullification by adjustment for concomitant standard anti-tuberculosis drugs. First, the rate difference in major adverse events between cases and controls was predominantly related to standard anti-tuberculosis drugs. Second, levofloxacin added to various combinations of standard anti-tuberculosis drugs did not affect patient tolerance. Notwithstanding the intrinsic non-comparability of groups arising out of the very reason levofloxacin was employed, the study by Marra F et al demonstrated a plausible way to disentangle the effect of individual agents in the often complex combination regimens. Their observation corroborates our experience[2] and further illustrates the potential usefulness of levofloxacin in the treatment of tuberculosis that is complicated by patient intolerance or bacillary resistance to first-line drugs. Although various adverse effects, including serious ones, have been reported with the long-term use of ofloxacin (and perhaps also levofloxacin), they are not frequent enough to preclude the use of ofloxacin/levofloxacin in the indicated settings[3-5]. References 1.Marra F, Marra CA, Moadebi S, et al. Levofloxacin treatment of active tuberculosis and the risk of adverse events. Chest 2005; 128: 1406- 13. 2.Yew WW, Chan CK, Leung CC, et al. Comparative roles of levofloxacin and ofloxacin in the treatment of multidrug-resistant tuberculosis: preliminary results of a retrospective study from Hong Kong. Chest 2003; 124:1476-81. 3.Yew WW, Wong CF, Wong PC, Lee J, Chau CH. Adverse neurological reactions in patients with multidrug-resistant pulmonary tuberculosis after coadministration of cycloserine and ofloxacin. Clin Infect Dis 1993; 17:288-9. 4.Yew WW, Chau CH, Wen KH. Pseudomembranous colitis in a patient treated with ofloxacin for tuberculosis. Tuber Lung Dis 1996; 77:484. 5.Yew WW, Chau CH, Lee J. Superficial fungal infection of the skin during treatment of tuberculosis. Int J Tuberc Lung Dis 2002; 6:1132.