ABSTRACT
Introducción: Con frecuencia las fluoroquinolonas integran los esquemas de tratamiento de tuberculosis, tanto en aquellos con enfermedad multirresistente (parte esencial de la prescripción), como también en individuos con tuberculosis sensible e intolerancia a drogas de primera línea. Objetivos: Evaluar cuáles fueron las indicaciones para incluir fluoroquinolonas en el tratamiento antituberculosis y describir los eventos adversos relacionados con su utilización. Materiales y Métodos: Se realizó un análisis retrospectivo de pacientes que iniciaron tratamiento para tuberculosis entre el 1 de enero de 2014 y el 31 de diciembre de 2016. Definimos evento adverso como aquella condición que derivó en la suspensión de un medicamento o la necesidad de utilizar drogas específicas para su manejo. Se utilizó la prueba de c2 para las comparaciones entre grupos. Resultados: Entre los 267 pacientes que iniciaron tratamiento en el período descripto, recibieron fluoroquinolonas 24 individuos (11 hombres) representando el 9% del total; 19 se trataron con moxifloxacina 400 mg/día y el resto con levofloxacina 750 mg/día. Comparando los grupos con fluoroquinolonas vs. sin fluoroquinolonas, no hubo diferencias significativas en el porcentaje de participantes de sexo masculino (46 vs. 58%), edad (34.7 ± 12 vs. 35.1 ± 15 años), afectación pulmonar (58 vs. 68%) y proporción de abandonos (26 vs. 21%). Hubo una mayor proporción de argentinos en el grupo con fluoroquinolonas vs. sin fluoroquinolonas (71 vs. 44%, p = 0.012) y de individuos VIH positivos (46 vs. 8.6%, p < 0.05). Se indicaron fluoroquinolonas en reemplazo de rifampicina en 9 pacientes (37.5%) debido a la interacción de ésta con antirretrovirales, en 9 (37.5%) por intolerancia y en 5 (21%) por resistencia a anti TB de primera línea, en 1 por el antecedente de cirrosis (en lugar de pirazinamida). El tiempo de tratamiento con fluoroquinolonas fue de 203 ± 158 días (rango 30-660) sin observarse eventos adversos relacionados con su uso. Conclusión: En el grupo examinado el uso de fluoroquinolonas no se asoció a eventos adversos, siendo las indicaciones más frecuentes en estos pacientes las interacciones medicamentosas en pacientes VIH positivos y la intolerancia a las drogas de primera línea.
Introduction: The floroquinolones are frequently used in the treatment regimes for tuberculosis (TB) in both those with multidrug-resistant TB (MDR-TB), where it forms an essential part of the regimen, as well as intolerance to first-line drugs in the TB sensitive. Objectives: To evaluate the indications to include floroquinolones in TB treatment and to describe the adverse events associated with its use. Materials and Methods: A retrospective analysis of the patients who began treatment for TB between 1 January 2014 and 31 December 2016 was performed. We define adverse event as that condition that results in the suspension of a medicine or the need to use specific drugs for its management. Group characteristics were comparing by using c2 test. Results: Among the 267 patients who began treatment in the period described, 24 (11 men) received fluoroquinolones representing 9% of the total: 19 moxifloxacin 400 mg/day and the rest levofloxacin 750 mg/day. Comparing the groups with fluoroquinolones vs. without fluoroquinolones, there were no significant differences in the percentage of men (46 vs. 58%), age (34.7 ± 12 vs. 35.1 ± 15 years), pulmonary involvement (58 vs. 68%), and proportion of dropouts (26 vs. 21%). There was a higher proportion of Argentines in the group with fluoroquinolones vs. without fluoroquinolones (71 vs. 44%, p = 0,012) and HIV-positive (46 vs. 8.6%, p < 0.05). Fluoroquinolones were indicated in replacement of rifampicin in 9 patients (37.5%) due to the interaction with antiretroviral drugs, in 9 (37.5%) by intolerance and in 5 (21%) for resistance to first-line anti-TB drugs, in 1 by the history of cirrhosis (instead of pyrazinamide). The time of treatment with fluoroquinolones was 203 ± 158 days (range 30-660) with no observed adverse events related to its use. Conclusion: The use of fluoroquinolones was not associated with adverse events in the group of patients studied, drug interactions in HIV positive patients and the intolerance to first-line drugs were the most frequent indications in the studied group.
Subject(s)
Tuberculosis , Fluoroquinolones , LevofloxacinABSTRACT
Introduction: Fluoroquinolones are frequently used in treatment regimes for tuberculosis both in cases of multidrug-resistant tuberculosis, where they are an essential part of the regime, and also in cases of drug-sensitive tuberculosis with intolerance to first-line drugs. Objectives: To evaluate indications to include fluoroquinolones in the anti-tuberculosis treatment and to describe the adverse events associated with their use. Materials and Methods: A retrospective analysis of the patients who began treatment for tuberculosis between January 1, 2014 and December 31, 2016 was performed. We defined an adverse event as the condition that resulted in the suspension of a drug or the need to use specific drugs for its management. Group characteristics were compared by using the c2 test. Results: Of the 267 patients who began treatment in said period, 24 (11 men) received fluoroquinolones, representing 9% of the total population; 19 were treated with 400 mg/day of moxifloxacin and the rest with 750 mg/day of levofloxacin. In the comparison of the groups receiving fluoroquinolones versus the ones without fluoroquinolones, there were no significant differences in the percentage of male participants (46 vs. 58%), age (34.7 ± 12 vs. 35.1 ± 15 years), pulmonary involvement (58 vs. 68%) and withdrawal rate (26 vs. 21%). There was a higher proportion of Argentinians (71 vs. 44%, p = 0.012) and of HIV-positive individuals (46 vs. 8.6%) p < 0.05) in the group with fluoroquinolones vs. the group without fluoroquinolones. Fluoroquinolones were indicated in replacement of rifampicin in 9 patients (37.5%) due to its interaction with antiretroviral drugs, in 9 patients (37.5%) due to intolerance, and in 5 patients (21%) due to resistance to first-line anti-tuberculosis drugs. In one individual, fluoroquinolones were indicated instead of pyrazinamide due to history of cirrhosis. The time of treatment with fluoroquinolones was 203 ± 158 days (range 30-660) with no observed adverse events related to their use. Conclusion: In the group under study, the use of fluoroquinolones was not associated with adverse events. The most frequent indications in these patients were drug interactions in HIV-positive patients and intolerance to first-line drugs.
