Moxifloxacin and gatifloxacin for initial therapy of tuberculosis: a meta-analysis of randomized clinical trials.

Abstract

Moxifloxacin (MOX) and gatifloxacin (GAT) have exhibited promising mycobactericidal activity, and a number of clinical trials have been conducted in recent decades to compare the treatment efficacy of MOX-containing and/or GAT-containing regimens with the standard regimen. The aim of this meta-analysis for clinical trials of MOX- or GAT-containing regimens was to evaluate their treatment efficacy and safety in initial therapy for drug-sensitive tuberculosis (TB). Databases were searched for randomized controlled trials, and nine studies with 6980 patients were included. We found that fluoroquinolone substitution for isoniazid or ethambutol in short-course regimens might result in more frequent unfavorable treatment outcomes compared with the standard regimen-in particular, an increased incidence of relapse. In a per-protocol analysis, MOX-containing regimens had slightly higher rates of sputum culture conversion at two months than the standard regimen (RR 1.08, 95% CI 1.04-1.11, P <0.001); there was no significant difference in the rate of sputum conversion between the GAT-containing regimens and the standard regimen (RR 1.13, 95% CI 0.96-1.33, P = 0.13). There were no significant differences in the incidence of death from any cause, including TB, nor were there serious adverse events between the MOX- or GAT-containing regimens and the standard regimen. In conclusion, MOX or GAT might not have the ability to shorten treatment duration in the initial therapy for tuberculosis despite the non-inferiority or even slightly better efficacy in the early phase of treatment compared with the standard regimen. Furthermore, it is safe to include MOX or GAT in initial TB treatment.

• Authors: Qiaoling Ruan, Qihui Liu, Feng Sun, Lingyun Shao, Jialin Jin, Shenglei Yu, Jingwen Ai, Bingyan Zhang, Wenhong Zhang
• Journal: Emerging microbes & infections (Emerg Microbes Infect) Vol. 5 Pg. e12 (Feb 24 2016) ISSN: 2222-1751 [Electronic] United States
• PMID: 26905025 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Chemical References

• Antitubercular Agents
• Fluoroquinolones
• Gatifloxacin
• Moxifloxacin

Topics

• Adult
• Antitubercular Agents (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Female
• Fluoroquinolones (adverse effects, therapeutic use)
• Gatifloxacin
• Humans
• Male
• Moxifloxacin
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Tuberculosis (drug therapy, mortality, nursing)