Evaluation of Resistance to Levofloxacin Developing During Tuberculosis Treatment in Central South Mie Prefecture

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  • 三重県中南部の活動性肺結核患者における levofloxacin（LVFX）耐性の検討
  • 第93回日本感染症学会学術講演会座長推薦論文 三重県中南部の活動性肺結核患者におけるlevofloxacin(LVFX)耐性の検討
  • ダイ93カイ ニホン カンセンショウ ガッカイ ガクジュツ コウエンカイ ザチョウ スイセン ロンブン ミエケン ジュウ ナンブ ノ カツドウセイ ハイケッカク カンジャ ニ オケル levofloxacin(LVFX)タイセイ ノ ケントウ

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<p>Purpose : In Japan, levofloxacin (LVFX) was first launched in the market 1993, and the drug was approved as an anti-tuberculosis drug in 2016. It is prescribed as part of second-line treatment for patients who are at a high risk of developing drug resistance and adverse effects to first-line anti-tuberculosis drugs. Meanwhile, LVFX is a frequently used drug for the treatment of community-acquired pneumonia and urinary tract infection in Japan. However, development of resistant Escherichia coli and Streptococcus pneumoniae to LVFX has become a major issue ; in fact, the estimated average resistance rates at our hospital between April 2014 and March 2018 are 37.6% and 5.0%, respectively. However, only a few studies on the development of resistance of LVFX have been conducted. We investigated the usage of LVFX for lung tuberculosis at our hospital and susceptibility of the causative mycobacterial strains to LVFX.<BR> Methods ＆Materials : We retrospectively identified 83 consecutive patients with lung tuberculosis who were admitted to our hospital between April 2014 and March 2018 (age, 74±21 years ; sex, male/female 43/40 ; first treatment, 74 cases). We analyzed the outcomes of examination of resistance of the causative strains to isoniazid (INH), rifampin (RFP), streptomycin (SM), and LVFX recorded in the medical charts.<BR> Results : LVFX was administered as a component of the initial treatment regimen in 33 cases (83%) (74 ±21 years of age) and as a component of retreatment regimens in 7 cases (17%) (73±22 years of age). The reason for retreatment in the latter 7 cases were adverse reactions to the first-line treatment in 13 cases (37%) and development of resistance to the first-line anti-tuberculosis drugs in 2 cases (6%). The drug resistance rate was 5% for INH, 3% for RFP, 0% for SM, and 0% for LVFX. One of the two patients had multidrug resistance. No adverse effects were reported, and the bacteriological negative conversion rate was 100%. Only one patient had been treated with LVFX alone for 7 days prior to admission, but there was no evidence of development of resistance.<BR> Conclusion : LVFX was concluded as being an effective component of the tuberculosis treatment regimen in cases where standard regimens could not be administered, as it exerted no adverse effects and also had no adverse effect on the bacteriological negative conversion rates. While the usage rate of LVFX for lung tuberculosis at our hospital is more than 30%, we have never encountered any cases of tuberculosis with resistance as of 2018. Our study showed that LVFX is an essential drug for the treatment of tuberculosis if resistance/adverse effects limit the use of first-line drugs.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 94 (6), 828-833, 2020-11-20

    The Japanese Association for Infectious Diseases

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