Does empirical treatment of community-acquired pneumonia with fluoroquinolones delay tuberculosis treatment and result in fluoroquinolone resistance in Mycobacterium tuberculosis? Controversies and solutions

doi:10.1016/j.ijantimicag.2011.11.014

中山醫學大學機構典藏 CSMUIR > 醫學院 > 醫學系 > 期刊論文 > Item 310902500/18207

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Title:	Does empirical treatment of community-acquired pneumonia with fluoroquinolones delay tuberculosis treatment and result in fluoroquinolone resistance in Mycobacterium tuberculosis? Controversies and solutions
Authors:	Shen, G.-H.;Tsao, Tsao T.C.-Y.;Kao, S.-J.;Lee, J.-J.;Chen, Y.-H.;Hsieh, W.-C.;Hsu, G.-J.;Hsu, Y.-T.;Huang, C.-T.;Lau, Y.-J.;Tsao, S.-M.;Hsueh, P.-R.
Keywords:	Community-acquired pneumonia;Fluoroquinolone resistance;Fluoroquinolones;Multidrug-resistant Mycobacterium tuberculosis;Tuberculosis
Date:	2012
Issue Date:	2017-08-09T03:25:55Z (UTC)
ISSN:	9248579
Abstract:	The role of fluoroquinolones (FQs) as empirical therapy for community-acquired pneumonia (CAP) remains controversial in countries with high tuberculosis (TB) endemicity owing to the possibility of delayed TB diagnosis and treatment and the emergence of FQ resistance in Mycobacterium tuberculosis. Although the rates of macrolide-resistant Streptococcus pneumoniae and amoxicillin/clavulanic acid-resistant Haemophilus influenzae have risen to alarming levels, the rates of respiratory FQ (RFQ) resistance amongst these isolates remain relatively low. It is reported that ca. 1-7% of CAP cases are re-diagnosed as pulmonary TB in Asian countries. A longer duration (≥7 days) of symptoms, a history of night sweats, lack of fever (>38 °C), infection involving the upper lobe, presence of cavitary infiltrates, opacity in the lower lung without the presence of air, low total white blood cell count and the presence of lymphopenia are predictive of pulmonary TB. Amongst patients with CAP who reside in TB-endemic countries who are suspected of having TB, imaging studies as well as aggressive microbiological investigations need to be performed early on. Previous exposure to a FQ for >10 days in patients with TB is associated with the emergence of FQ-resistant M. tuberculosis isolates. However, rates of M. tuberculosis isolates with FQ resistance are significantly higher amongst multidrug-resistant M. tuberculosis isolates than amongst susceptible isolates. Consequently, in Taiwan and also in other countries with TB endemicity, a short-course (5-day) regimen of a RFQ is still recommended for empirical therapy for CAP patients if the patient is at low risk for TB. © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
URI:	http://dx.doi.org/10.1016/j.ijantimicag.2011.11.014 https://www.scopus.com/inward/record.uri?eid=2-s2.0-84862777057&doi=10.1016%2fj.ijantimicag.2011.11.014&partnerID=40&md5=61e253852c4974c0afbe802e6b01f16a https://ir.csmu.edu.tw:8080/ir/handle/310902500/18207
Relation:	International Journal of Antimicrobial Agents 39(3) ,201-205
Appears in Collections:	[醫學系] 期刊論文

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