Community-acquired pneumonia, tuberculosis, and the use of fluoroquinolones: an update

Abstract

Community-acquired pneumonia (CAP) and tuberculosis (TB) both continue to cause considerable morbidity, hospitalization and mortality worldwide. In patients presenting with a lower respiratory tract infection (LRTI), prompt and accurate differential diagnosis of CAP and TB is important, but not straightforward; clinical and chest image assessments are key. The high bacteriological and clinical efficacy of respiratory fluoroquinolones, such as moxifloxacin, underpins the importance of these antibiotics in the management of CAP. Data from different clinical studies suggest that the development of fluoroquinolone resistance in TB is associated with repeated and/or prolonged courses of treatment with less potent fluoroquinolone agents or treatment regimens, often for dubious indications. In many countries, the inappropriate use of fluoroquinolones reflects inadequacies of the healthcare system, and better stewardship of these important antibiotics is needed. With this proviso, the use of respiratory fluoroquinolones for empiric antibiotic therapy according to clinical guidelines for CAP, and as indicated for other LRTIs, remains an appropriate and effective therapeutic strategy, even in TB-endemic regions.