Journal Article

Choice between Levofloxacin and Moxifloxacin and Multidrug-Resistant Tuberculosis Treatment Outcomes

Hyun Kyung Lee, Won-Jung Koh, Seung Hun Jang, Eun Young Heo, Yon Ju Ryu, Tae Sun Shim, Won-Il Choi, Yee Hyung Kim, Kyeongman Jeon, Young Ae Kang, Ki Uk Kim, Jae Ho Lee, Soo-Jung Um, Yong Il Hwang, Changhoon Lee, Ki Hwan Jung, Sang Bong Choi, Yong Soo Kwon, Kyung Chan Kim, Jae-Joon Yim, Jae Chol Choi, Seung Heon Lee, Sejoong Kim, Kwang Ha Yoo

2016

Overview

We previously showed that the choice of levofloxacin or moxifloxacin for the treatment of patients with fluoroquinolone-sensitive multidrug-resistant tuberculosis (MDR-TB) did not affect sputum culture conversion at 3 months of treatment. To compare final treatment outcomes between patients with MDR-TB randomized to levofloxacin or moxifloxacin. A total of 151 participants with MDR-TB who were included for the final analysis in our previous trial were followed through the end of treatment. Treatment outcomes were compared between 77 patients in the levofloxacin group and 74 in the moxifloxacin group, based on the 2008 World Health Organization definitions as well as 2013 revised definitions of treatment outcomes. In addition, the time to culture conversion was compared between the two groups. Treatment outcomes were not different between the two groups, based on 2008 World Health Organization definitions as well as 2013 definitions. With 2008 definitions, cure was achieved in 54 patients (70.1%) in the levofloxacin group and 54 (73.0%) in the moxifloxacin group (P = 0.72). Treatment success rates, including cure and treatment completed, were not different between the two groups (87.0 vs. 81.1%, P = 0.38). With 2013 definitions, cure rates (83.1 vs. 78.4%, P = 0.54) and treatment success rates (84.4 vs. 79.7%, P = 0.53) were also similar between the levofloxacin and moxifloxacin groups. Time to culture conversion was also not different between the two groups (27.0 vs. 45.0 d, P = 0.11 on liquid media; 17.0 vs. 42.0 d, P = 0.14 on solid media). Patients in the levofloxacin group had more adverse events than those in the moxifloxacin group (79.2 vs. 63.5%, P = 0.03), especially musculoskeletal ones (37.7 vs. 14.9%, P = 0.001). The choice of levofloxacin or moxifloxacin made no difference to the final treatment outcome among patients with fluoroquinolone-sensitive MDR-TB. Clinical trial registered with www.clinicalrials.gov (NCT01055145).

• Publisher: American Thoracic Society,Oxford University Press
• Subject: Adult / Anti-Bacterial Agents / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - adverse effects / Female / fluoroquinolones / Fluoroquinolones - administration & dosage / Fluoroquinolones - adverse effects / Humans / Levofloxacin / Levofloxacin - administration & dosage / Levofloxacin - adverse effects / Logistic Models / Male / Middle Aged / Moxifloxacin / Multidrug-resistant tuberculosis / Multidrug-Resistant/drug therapy / Multivariate Analysis / Proportional Hazards Models / Prospective Studies / Republic of Korea / Treatment Outcome / Tuberculosis / Tuberculosis, Multidrug-Resistant / Tuberculosis, Multidrug-Resistant - drug therapy