title: Community-acquired pneumonia and tuberculosis: differential diagnosis and the use of fluoroquinolones.
abstract: The respiratory fluoroquinolones moxifloxacin, gemifloxacin, and high-dose levofloxacin are recommended in guidelines for effective empirical antimicrobial therapy of community-acquired pneumonia (CAP). The use of these antibiotics for this indication in areas with a high prevalence of tuberculosis (TB) has been questioned due to the perception that they contribute both to delays in the diagnosis of pulmonary TB and to the emergence of fluoroquinolone-resistant strains of Mycobacterium tuberculosis. In this review, we consider some of the important questions regarding the potential use of fluoroquinolones for the treatment of CAP where the burden of TB is high. The evidence suggests that the use of fluoroquinolones as recommended for 5-10 days as empirical treatment for CAP, according to current clinical management guidelines, is appropriate even in TB-endemic regions. It is critical to quickly exclude M. tuberculosis as a cause of CAP using the most rapid relevant diagnostic investigations in the management of all patients with CAP.
authors.affiliation: University of Toronto, 2300 Eglinton Ave West, Suite 201, Mississauga, Ontario, L5M 2V8, Canada. Electronic address: RGrossman@cvh.on.ca.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Grossman
authors.affiliation: Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: School of Medicine, University of St Andrews, St Andrews, Fife, UK.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gillespie
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda Milano, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy; D015995:Prevalence; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Differential diagnosis; Fluoroquinolone; Mycobacterium tuberculosis; Pneumonia; Resistance; Tuberculosis