title: Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Current guidelines for treating community-acquired pneumonia recommend the use of fluoroquinolones for high-risk patients. Previous studies have reported controversial results as to whether fluoroquinolones are associated with delayed diagnosis and treatment of pulmonary tuberculosis (TB) and the development of fluoroquinolone-resistant Mycobacterium tuberculosis. We performed a systematic review and meta-analysis to clarify these issues.
  
  
  METHODS
  The following databases were searched through September 30, 2010: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, BIOSIS Previews, and the ACP Journal Club. We considered studies that addressed the issues of delay in diagnosis and treatment of TB and the development of resistance.
  
  
  RESULTS
  Nine eligible studies (four for delays and five for resistance issues) were included in the meta-analysis from the 770 articles originally identified in the database search. The mean duration of delayed diagnosis and treatment of pulmonary TB in the fluoroquinolone prescription group was 19.03 days, significantly longer than that in the non-fluoroquinolone group (95% confidence interval (CI) 10.87 to 27.18, p<0.001). The pooled odds ratio of developing a fluoroquinolone-resistant M. tuberculosis strain was 2.70 (95% CI 1.30 to 5.60, p=0.008). No significant heterogeneity was found among studies in the meta-analysis.
  
  
  CONCLUSIONS
  Empirical fluoroquinolone prescriptions for pneumonia are associated with longer delays in diagnosis and treatment of pulmonary TB and a higher risk of developing fluoroquinolone-resistant M. tuberculosis.
authors.affiliation: Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Wei-Ru
authors.initials: WR
authors.lastname: Lin
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D016208:Databases, Factual; D057210:Delayed Diagnosis; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D009169:Mycobacterium tuberculosis; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D024841:Fluoroquinolones