fluoroquinolone and TB connection

Q: What is the caveat of using fluoroquinolones in areas endemic to Mycobacterium tuberculosis (TB)?

Answer:

Widespread prophylactic and empiric use of fluoroquinolones should be avoided, and caution should be exercised in areas known to be TB endemic. As respiratory symptoms are almost the same, an appropriate assessment for tuberculosis infection should be performed first. 

The use of fluoroquinolones in patients with TB is associated with delay in diagnosis, an increase in resistance, and poor outcomes.

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References:

1. Dooley KE, Golub J, Goes FS, et al. Empiric treatment of community-acquired pneumonia with fluoroquinolones, and delays in the treatment of tuberculosis. Clin Infect Dis 2002; 34:1607.

2. Yoon YS, Lee HJ, Yoon HI, et al. Impact of fluoroquinolones on the diagnosis of pulmonary tuberculosis initially treated as bacterial pneumonia. Int J Tuberc Lung Dis 2005; 9:1215.

3. Ginsburg AS, Grosset JH, Bishai WR. Fluoroquinolones, tuberculosis, and resistance. Lancet Infect Dis 2003; 3:432.

4. Long R, Chong H, Hoeppner V, et al. Empirical treatment of community-acquired pneumonia and the development of fluoroquinolone-resistant tuberculosis. Clin Infect Dis 2009; 48:1354.

5. Wang JY, Hsueh PR, Jan IS, et al. Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas. Thorax 2006; 61:903.