Fluoroquinolones may delay the diagnosis of tuberculosis.
BACKGROUND
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).


CONCLUSIONS
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.
Ang
D
D
Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
Hsu
A A L
AA
Tan
B H
BH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D003951:Diagnostic Errors; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones