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Moxifloxacin Speeds Culture Conversion During TB Treatment
The proportion of patients who are culture negative at 8 weeks is greater with TB treatments containing moxifloxacin than with those containing ethambutol.
Moxifloxacin, a fourth-generation fluoroquinolone, has demonstrated potent in vitro activity against Mycobacterium tuberculosis. Now, investigators in Brazil have conducted a phase II, double-blind trial to assess the potential role of this drug in treating adults with sputum smear–positive pulmonary TB. HIV-infected individuals with CD4 counts <200 cells/mm3 were excluded.
A total of 170 patients were randomized to receive moxifloxacin (donated by industry) or ethambutol — in addition to isoniazid (INH), rifampicin, and pyrazinamide — 5 days per week for 8 weeks; treatment was directly observed. They then received 4 months of twice-weekly INH and rifampicin. Follow-up continued for at least 1 year beyond completion of all therapy. Modified intent-to-treat analyses of the primary outcome (culture conversion) excluded patients whose baseline cultures were negative, were contaminated, or showed evidence of resistance to INH, rifampicin, or ethambutol.
After only 1 week of treatment, significantly more patients in the moxifloxacin group than in the ethambutol group had negative sputum cultures. At 8 weeks, 80% of moxifloxacin recipients (59 of 74) had converted to sputum culture negative, compared with only 63% of ethambutol recipients (45 of 72). Only one serious adverse event was attributed to a study drug (ethambutol). Five percent of patients had late relapse (or reinfection), with no difference between groups.
Comment: The more-rapid culture conversion observed with the addition of moxifloxacin in this study is encouraging because it suggests that a shorter course of treatment might work. One editorial notes the potential use of moxifloxacin in treating uncomplicated multidrug-resistant TB. Another editorial focuses on the shortcomings of global TB-control programs: the separate treatment sites for HIV and TB in most areas, poor case-detection rates, inadequate laboratory support, inappropriate treatment in many areas, and (especially) underfunding. Unfortunately, moxifloxacin will not address the problem of extensively drug-resistant TB.
Published in Journal Watch Infectious Diseases April 15, 2009
Citation(s):
Conde MB et al. Moxifloxacin versus ethambutol in the initial treatment of tuberculosis: A double-blind, randomised, controlled phase II trial. Lancet 2009 Apr 4; 373:1183.
- Medline abstract (Free)
Rieder HL. Fourth-generation fluoroquinolones in tuberculosis. Lancet 2009 Apr 4; 373:1148.
- Medline abstract (Free)
Crunch time for tuberculosis control. Lancet 2009 Apr 4; 373:1145.
- Medline abstract (Free)
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- Moxifloxacin and TB
Reuben N NKADO MD, Lagos, Nigeria, 21 Apr 2009 6:10 PM EST
This study gives some hope in the battle against TB, especially with its recent upsurge in association with HIV/AIDS. I... [more] - Moxifloxacin Speeds Culture Conversion During TB Treatment
M Vasbinder, 21 Apr 2009 6:10 PM EST
Knowing this, moxifloacin ought to be kept as reserve antibiotic and not be used for "normal" infections.
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