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Fluoroquinolones may provide treatment option for children with resistant TB
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Levofloxacin and moxifloxacin may provide treatment alternatives for children who may have multidrug-resistant tuberculosis, but use of these medications in this age group should be carefully monitored, according to data reported online recently.
Jean-Vannak Chauny, of the Service de Pharmacie, Hopital Robert Debre, Paris, and colleagues reported data on six French children who were treated in a university hospital between 2005 and 2011 and received treatment with levofloxacin (Levaquin, Janssen Pharmaceuticals) and moxifloxacin (Avelox, Merck) for TB.
Four of the children were cured completely, one patient had pulmonary symptoms at the end of treatment and one child was lost to follow-up, according to the study findings.
Although fluoroquinolones are not licensed by the FDA or the European Medicines Agency for use in children, they can be used for children with severe infections, the researchers said. In other studies of fluoroquinolone use in children, arthralgia, musculoskeletal disorders and other adverse events have been noted. In this study, one child reportedly developed polyarthritis, but the symptoms resolved after cessation of treatment.
“Patients prescribed fluoroquinolones should be informed of the possibility of developing arthralgia, arthromyalgia or Achilles tendinopathies on treatment, together with the possibility of photosensitivity and peripheral neuropathies,” Chauny and colleagues said.
However, they said these treatments may provide a treatment alternative for children with severe infections.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Jeffrey R. Starke, MD
This is a very small study from France that includes six patients, with only three patients being younger than aged 12 years. Many centers in high-burden countries, and even some centers in the United States, have far more extensive experience with the use of fluoroquinolones to treat tuberculosis in children. They are used routinely in the management of multidrug-resistant TB disease and are being used more frequently for the treatment of TB infection, even in very small children with few apparent adverse reactions.
It is unclear if a fluoroquinolone alone is adequate for treatment of TB infection, or if it needs to be combined with another drug. Levofloxacin has replaced ciprofloxacin for treating children, although the optimal dosing for children with TB has not been established. The third-generation fluoroquinolone, moxifloxacin, is more potent against Mycobacterium tuberculosis than levofloxacin, and might be effective against strains that are phenotypically resistant to other fluoroquinolones, but almost no pharmacokinetic data for small children are available.
The consensus is that these drugs are quite safe and very effective in children with MDR TB. Severe adverse reactions appear to be rare, despite the fact that the drug often must be given for 12 to 18 months, and the feared effect on joints and growing cartilage observed in juvenile animal studies has not been observed in children treated for MDR TB.
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