Four-Month Moxifloxacin-Based Regimens for Drug-Sensitive Tuberculosis

• Published in: The New England journal of medicine Vol. 371; no. 17; pp. 1577 - 1587
• Main Authors: Gillespie, Stephen H, Crook, Angela M, McHugh, Timothy D, Mendel, Carl M, Meredith, Sarah K, Murray, Stephen R, Pappas, Frances, Phillips, Patrick P.J, Nunn, Andrew J
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 23.10.2014
• Subjects: Adult; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Double-Blind Method; Double-blind studies; Drug Administration Schedule; Drug development; Drug therapy; Drug Therapy, Combination; Ethambutol; Ethambutol - therapeutic use; Female; Fluoroquinolones - adverse effects; Fluoroquinolones - therapeutic use; General aspects; HIV Seropositivity - complications; Human bacterial diseases; Humans; Infectious diseases; Isoniazid; Isoniazid - therapeutic use; Kaplan-Meier Estimate; Male; Medical sciences; Motivation; Moxifloxacin; Mycobacterium tuberculosis - isolation & purification; Patients; Pharmacology. Drug treatments; Pyrazinamide; Pyrazinamide - therapeutic use; Rifampin; Rifampin - therapeutic use; Sensitivity analysis; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - drug therapy; Young Adult; United Kingdom > UK; South Africa; Infection; Medicine; Fluoroquinolone derivatives; Tuberculosis; Bacteriosis; Mycobacterial infection; Moxifloxacin; Antibacterial agent; Quinolone derivatives
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1407426

One approach to improving tuberculosis therapy is to shorten the duration from 6 months to 4 months. In this trial in over 1900 patients with smear-positive tuberculosis, two 4-month moxifloxacin-based regimens did not perform as well as the standard 6-month regimen. A short-term tuberculosis treatment regimen could improve rates of adherence, reduce rates of adverse events, and lower costs. Fluoroquinolones have shown promising activity against mycobacteria 1 and are established as a critical component of the treatment of multidrug-resistant tuberculosis, 2 , 3 with later fluoroquinolones recognized as having a more potent effect. It has been proposed that these drugs may have a role in reducing the duration of tuberculosis treatment. 4 Moxifloxacin has been approved for a range of indications globally. 5 It has favorable pharmacokinetics, a large volume of distribution, and penetration into epithelial-lining fluid and macrophages. 6 – 8 The activity of moxifloxacin in vitro . . .