Limited tolerability of levofloxacin and pyrazinamide for multidrug-resistant tuberculosis prophylaxis in a solid organ transplant population.
OBJECTIVE
To determine the long-term tolerability of prophylactic administration of pyrazinamide and levofloxacin in patients possibly exposed to multidrug-resistant tuberculosis (MDRTB) after undergoing solid organ transplantation.


METHODS
Retrospective analysis.


METHODS
Community outpatient clinic.


METHODS
Forty-eight recipients of solid organ transplants beginning prophylaxis for MDRTB during August 1999 after possible exposure to a single index case of multidrug-resistant Mycobacterium tuberculosis within our community


METHODS
Prophylaxis consisted of pyrazinamide 30 mg/kg/day plus levofloxacin 500 mg/day, administered for 1 year.


RESULTS
Thirteen (27.1%) of the 48 patients completed therapy; 27 (56.3%) discontinued therapy within 4 months due to adverse drug events. Gastrointestinal intolerance was the major adverse event resulting in early discontinuation.


CONCLUSIONS
Prophylaxis of MDRTB with levofloxacin and pyrazinamide was associated with limited tolerability due to the high frequency of adverse events. While we search for a better tolerated prophylactic regimen, close monitoring for adverse reactions is recommended.
Lou
Huei-Xin
HX
Department of Pharmacy, Singapore General Hospital.
Shullo
Michael A
MA
McKaveney
Teresa P
TP
D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000009:adverse effects* / Q000627:therapeutic use; D016377:Organ Transplantation / Q000009:adverse effects*; D011718:Pyrazinamide / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D014181:Transplantation Immunology; D014376:Tuberculosis / Q000382:microbiology* / Q000517:prevention & control*
D000890:Anti-Infective Agents; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D011718:Pyrazinamide; D064704:Levofloxacin; D015242:Ofloxacin