Community-acquired pneumonia and tuberculosis : differential diagnosis and the use of fluoroquinolones
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The respiratory fluoroquinolones moxifloxacin, gemifloxacin, and high-dose levofloxacin are recommended in guidelines for effective empirical antimicrobial therapy of community-acquired pneumonia (CAP). The use of these antibiotics for this indication in areas with a high prevalence of tuberculosis (TB) has been questioned due to the perception that they contribute both to delays in the diagnosis of pulmonary TB and to the emergence of fluoroquinolone-resistant strains of Mycobacterium tuberculosis. In this review, we consider some of the important questions regarding the potential use of fluoroquinolones for the treatment of CAP where the burden of TB is high. The evidence suggests that the use of fluoroquinolones as recommended for 5-10 days as empirical treatment for CAP, according to current clinical management guidelines, is appropriate even in TB-endemic regions. It is critical to quickly exclude M. tuberculosis as a cause of CAP using the most rapid relevant diagnostic investigations in the management of all patients with CAP.
Grossman , R F , Hsueh , P-R , Gillespie , S H & Blasi , F 2014 , ' Community-acquired pneumonia and tuberculosis : differential diagnosis and the use of fluoroquinolones ' International Journal of Infectious Diseases , vol 18 , no. 1 , pp. 14-21 . DOI: 10.1016/j.ijid.2013.09.013
International Journal of Infectious Diseases
© 2013 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This article is based on the content of a presentation by R.F. Grossman entitled ‘‘Fluoroquinolones: a role in CAP and TB’’, part of the CME symposium entitled ‘‘Fluoroquinolones: CAP, TB and the importance of differential diagnosis’’ at the 15 th International Congress on Infectious Diseases (ICID), Bangkok, Thailand, June 13–16, 2012, which was sponsored by Bayer HealthCare (Germany).
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