Fluoroquinolones may delay the diagnosis of tuberculosis

Ang D, Hsu AAL, Tan BH
Correspondence: Dr Tan Ban Hock, gimtbh@sgh.com.sg

ABSTRACT
Introduction Fluoroquinolones (FQs), frequently used for many common infections such as community-acquired pneumonia and urinary tract infection, are also effective against Mycobacterium tuberculosis. This study describes a series of patients in whom the empirical use of FQs for what appeared to be common community-acquired infections led to a delay in the diagnosis of tuberculosis (TB).
Methods We reviewed the records of five patients with TB in whom the early use of FQs led to partial symptom resolution and a prolonged relapsing and remitting course.
Results Of the five patients described, four presented with community-acquired pneumonia and one with urinary tract infection. All were given FQs and improved, though not completely. Their illnesses took a relapsing and remitting course. TB was eventually diagnosed, in four of them by culture and in one by characteristic histopathology (this patient required surgical resection of a lung abscess).
Conclusion FQs may lead to partial symptom resolution in TB. We highlight the problem of a delayed diagnosis, and voice our concern about inadvertent monotherapy of TB in such cases.

Keywords: fluoroquinolones, Mycobacterium tuberculosis, tuberculosis
Singapore Med J 2006; 47(9): 747-751