title: Early and extended early bactericidal activity of levofloxacin, gatifloxacin and moxifloxacin in pulmonary tuberculosis.
abstract: OBJECTIVE
  To evaluate the early bactericidal activity (EBA) of the new fluoroquinolones levofloxacin, gatifloxacin and moxifloxacin in patients with pulmonary tuberculosis (PTB).
  
  
  METHODS
  Randomized, open-label trial. Forty adults with newly diagnosed smear-positive PTB (10 per arm) were assigned to receive isoniazid (INH) 300 mg, levofloxacin 1000 mg, gatifloxacin 400 mg, or moxifloxacin 400 mg daily for 7 days. Sputum for quantitative culture was collected for 2 days before and daily during 7 days of monotherapy. Bactericidal activity was estimated by measuring the decline in bacilli during the first 2 days (EBA 0-2) and last 5 days of monotherapy (extended EBA, EBA 2-7). Laboratory staff were blinded to treatment assignment.
  
  
  RESULTS
  The EBA 0-2 of INH (0.67 log10 cfu/ml/day) was greater than that of moxifloxacin and gatifloxacin (0.33 and 0.35 log10 cfu/ml/day, respectively), but not of levofloxacin 1000 mg daily (0.45 log10 cfu/ml/day) (P = 0.14). Bactericidal activity between days 2 and 7 was similar for all three fluoroquinolones. In a pooled comparison, the EBA 2-7 of the fluoroquinolones was greater than for INH.
  
  
  CONCLUSIONS
  Moxifloxacin, gatifloxacin, and high-dose levofloxacin have excellent EBA, only slightly less than for INH, and greater extended EBA. These drugs warrant further study in the treatment of drug-susceptible TB.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106-5083, USA. jlj@case.edu
authors.forename: J L
authors.initials: JL
authors.lastname: Johnson
authors.forename: D J
authors.initials: DJ
authors.lastname: Hadad
authors.forename: W H
authors.initials: WH
authors.lastname: Boom
authors.forename: C L
authors.initials: CL
authors.lastname: Daley
authors.forename: C A
authors.initials: CA
authors.lastname: Peloquin
authors.forename: K D
authors.initials: KD
authors.lastname: Eisenach
authors.forename: D D
authors.initials: DD
authors.lastname: Jankus
authors.forename: S M
authors.initials: SM
authors.lastname: Debanne
authors.forename: E D
authors.initials: ED
authors.lastname: Charlebois
authors.forename: E
authors.initials: E
authors.lastname: Maciel
authors.forename: M
authors.initials: M
authors.lastname: Palaci
authors.forename: R
authors.initials: R
authors.lastname: Dietze
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001372:Aza Compounds / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D000077734:Gatifloxacin; D006801:Humans; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use*; D016037:Single-Blind Method; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D015242:Ofloxacin; D000077734:Gatifloxacin; D000077266:Moxifloxacin