Moxifloxacin and pyrazinamide susceptibility testing in a complex case of multidrug-resistant tuberculosis [Case study]

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 3; pp. 417 - 420
• Main Authors: FEASEY, N. A, POND, M, COLEMAN, D, SOLOMON, A. W, COSGROVE, C. A, DELGADO, R, BUTCHER, P. D, MITCHISON, D. A, HARRISON, T
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.03.2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antitubercular Agents - pharmacology; Aza Compounds - pharmacology; Bacterial diseases; Biological and medical sciences; Drug Therapy, Combination; Fluoroquinolones; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Microbial Sensitivity Tests; Multidrug-Resistant; Mycobacterium; Pharmacology. Drug treatments; Pneumology; Pyrazinamide; Pyrazinamide - pharmacology; Quinolines - pharmacology; Respiratory system : syndromes and miscellaneous diseases; Treatment Outcome; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - microbiology; Human; Drug susceptibility test; Respiratory disease; Mycobacterial infection; Moxifloxacin; Pyrazinamide; Complexes; multidrug-resistant; Infection; Case study; Tuberculosis; Multiple resistance; Bacteriosis; Antituberculous agent; fluoroquinolones; Antibacterial agent; Pneumology
• ISSN: 1027-3719; 1815-7920

Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of global concern. It is critical that drug susceptibility testing (DST) methods accurately predict clinical response. We present a patient with a challenging case of MDR-TB with additional resistance to quinolones and pyrazinamide. Treatment with a regimen including high-dosage moxifloxacin, based on additional genotypic and phenotypic DST, produced excellent results. This case highlights the possibility of treatment with high-dose fluoroquinolones despite apparent bacterial resistance to these agents. Improved DST methods are necessary for both agents. Development of genotypic approaches may offer a susceptibility profile rapidly, enabling early introduction of individualised treatments.