title: Moxifloxacin and pyrazinamide susceptibility testing in a complex case of multidrug-resistant tuberculosis.
abstract: Multidrug-resistant tuberculosis (MDR-TB) is a public health problem of global concern. It is critical that drug susceptibility testing (DST) methods accurately predict clinical response. We present a patient with a challenging case of MDR-TB with additional resistance to quinolones and pyrazinamide. Treatment with a regimen including high-dosage moxifloxacin, based on additional genotypic and phenotypic DST, produced excellent results. This case highlights the possibility of treatment with high-dose fluoroquinolones despite apparent bacterial resistance to these agents. Improved DST methods are necessary for both agents. Development of genotypic approaches may offer a susceptibility profile rapidly, enabling early introduction of individualised treatments.
authors.affiliation: Malawi Liverpool Wellcome Trust, Blantyre, Malawi. n_feasey@hotmail.com
authors.forename: N A
authors.initials: NA
authors.lastname: Feasey
authors.forename: M
authors.initials: M
authors.lastname: Pond
authors.forename: D
authors.initials: D
authors.lastname: Coleman
authors.forename: A W
authors.initials: AW
authors.lastname: Solomon
authors.forename: C A
authors.initials: CA
authors.lastname: Cosgrove
authors.forename: R
authors.initials: R
authors.lastname: Delgado
authors.forename: P D
authors.initials: PD
authors.lastname: Butcher
authors.forename: D A
authors.initials: DA
authors.lastname: Mitchison
authors.forename: T
authors.initials: T
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology*; D001372:Aza Compounds / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D011718:Pyrazinamide / Q000494:pharmacology*; D011804:Quinolines / Q000494:pharmacology*; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D011718:Pyrazinamide; D000077266:Moxifloxacin