Treatment of Chronic Q Fever: Clinical Efficacy and Toxicity of Antibiotic Regimens.

Abstract

Background:

Evidence on the effectiveness of first-line treatment for chronic Q fever, tetracyclines (TET) plus hydroxychloroquine (HCQ), and potential alternatives is scarce.

Methods:

We performed a retrospective, observational cohort study to assess efficacy of treatment with TET plus quinolones (QNL), TET plus QNL plus HCQ, QNL monotherapy, or TET monotherapy compared to TET plus HCQ in chronic Q fever patients. We used a time-dependent Cox proportional hazards model to assess our primary (all-cause mortality) and secondary outcomes (first disease-related event and therapy failure).

Results:

We assessed 322 chronic Q fever patients; 276 (86%) received antibiotics. Compared to TET plus HCQ (n = 254; 92%), treatment with TET plus QNL (n = 49; 17%), TET plus QNL plus HCQ (n = 29, 10%), QNL monotherapy (n = 93; 34%), or TET monotherapy (n = 54; 20%) were not associated with primary or secondary outcomes. QNL and TET monotherapies were frequently discontinued due to insufficient clinical response (n = 27, 29% and n = 32, 59%). TET plus HCQ, TET plus QNL, and TET plus QNL plus HCQ were most frequently discontinued due to side effects (n = 110, 43%; n = 13, 27%; and n = 12, 41%).

Conclusions:

Treatment of chronic Q fever with TET plus QNL appears to be a safe alternative for TET plus HCQ, for example, if TET plus HCQ cannot be tolerated due to side effects. Treatment with TET plus QNL plus HCQ was not superior to treatment with TET plus HCQ, although this may be caused by confounding by indication. Treatment with TET or QNL monotherapy should be avoided; switches due to subjective, insufficient clinical response were frequently observed.

• Authors: Sonja E van Roeden, Chantal P Bleeker-Rovers, Marieke J A de Regt, Linda M Kampschreur, Andy I M Hoepelman, Peter C Wever, Jan Jelrik Oosterheert
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 66 Issue 5 Pg. 719-726 (02 10 2018) ISSN: 1537-6591 [Electronic] United States
• PMID: 29040457 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents
• Quinolones
• Tetracyclines
• Hydroxychloroquine

Topics

• Aged
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Chronic Disease (drug therapy)
• Coxiella burnetii
• Drug Therapy, Combination
• Female
• Humans
• Hydroxychloroquine (adverse effects, therapeutic use)
• Male
• Middle Aged
• Propensity Score
• Proportional Hazards Models
• Q Fever (drug therapy, mortality)
• Quinolones (adverse effects, therapeutic use)
• Retrospective Studies
• Tetracyclines (adverse effects, therapeutic use)
• Treatment Failure