Fluoroquinolone exposure prior to tuberculosis diagnosis is associated with an increased risk of death.

van der Heijden YF, Maruri F, Blackman A, Holt E, Warkentin JV, Shepherd BE, Sterling TR
Int J Tuberc Lung Dis. 2012 16 (9): 1162-7

PMID: 22794509 · PMCID: PMC3981533 · DOI:10.5588/ijtld.12.0046

SETTING - Fluoroquinolone (FQ) exposure before tuberculosis (TB) diagnosis is common, but its effect on outcomes, including mortality, is unclear.

DESIGN - Among TB patients reported to the Tennessee Department of Health from 2007 to 2009, we assessed FQ exposure within 6 months before TB diagnosis. The primary outcome was the combined endpoint of death at the time of TB diagnosis and during anti-tuberculosis treatment.

RESULTS - Among 609 TB cases, 214 (35%) received FQs within 6 months before TB diagnosis. A total of 71 (12%) persons died; 10 (2%) were dead at TB diagnosis and 61 (10%) died during anti-tuberculosis treatment. In multivariable logistic regression analysis, factors independently associated with death were older age (OR 1.05 per year, 95%CI 1.04-1.07), human immunodeficiency virus infection (OR 8.08, 95%CI 3.83-17.06), US birth (OR 3.03, 95%CI 1.03-9.09), and any FQ exposure before TB diagnosis (OR 1.82, 95%CI 1.05-3.15). Persons with FQ exposure before TB diagnosis were more likely to have culture- and smear-positive disease than unexposed persons.

CONCLUSIONS - Among this patient population, FQ exposure before TB diagnosis was associated with an increased risk of death. These findings underscore the need for cautious use of FQs in persons with possible TB.

MeSH Terms (26)

Adult Aged Age Factors Anti-Bacterial Agents Antitubercular Agents Coinfection Drug Resistance, Multiple, Bacterial Female Fluoroquinolones HIV Infections Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Multivariate Analysis Mycobacterium tuberculosis Odds Ratio Prospective Studies Risk Assessment Risk Factors Sputum Tennessee Time Factors Treatment Outcome Tuberculosis, Pulmonary

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