Moxifloxacin as an Alternative or Additive Therapy for Treatment of Pulmonary Tuberculosis

Objective:To evaluate clinical studies on the role of moxifloxacin in the treatment of pulmonary tuberculosis (TB).Data Sources:A literature search was conducted using MEDLINE (1960-July 2011). Key search terms were moxifloxacin, BAY 12-8039, fluoroquinolones, and TB. References of review articles and of a Cochrane Review were also evaluated.Study Selection and Data Extraction:All articles published in English were evaluated. Prospective studies that evaluated the use of moxifloxacin in addition to or in substitution for first-line TB therapies were reviewed and included. Case series and retrospective studies were excluded.Data Synthesis:Four 8-week clinical trials were included. All had comparator regimens containing standard doses of rifampin, isoniazid, ethambutol, and pyrazinamide. Two evaluated the substitution of moxifloxacin for ethambutol, 1 evaluated the substitution of moxifloxacin for isoniazid, and 1 studied the addition of moxifloxacin to a standard regimen. The dose of moxifloxacin was 400 mg daily in all studies, but dosing frequency differed from 3 to 7 days per week. All used culture conversion at 8 weeks as the primary end point, although they coliected cultures at different times. Only 1 study found a significant difference in time to culture conversion at 8 weeks. One study found no significant difference at any point during the study. The other 2 studies found a significant difference in time to culture conversion at 4 and 6 weeks. In all trials, moxifloxacin was well tolerated, with nausea being the only significant adverse effect reported compared to the other arms of the studies.Conclusions:Although it cannot be stated definitively, available evidence suggests that moxifloxacin appears to be as effective as ethambutol and is possibly as effective as isoniazid In the treatment of pulmonary TB. Given the generally poor second-line options for the treatment of TB, moxifloxacin Is an attractive option as an alternative drug in TB treatment.