Evidence map›Paper›PMID 31371444›Full record

ArticleThe European respiratory journal2019

Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance.

Helen R Stagg, Graham H Bothamley, Jennifer A Davidson, Heinke Kunst, Maeve K Lalor, Marc C Lipman, Miranda G Loutet, Stefan Lozewicz, Tehreem Mohiyuddin, Aula Abbara and 14 more

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In one paragraph

Article in The European respiratory journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
  6. Isoniazid-resistant TB: treatment outcomes and impact of regimens with fluoroquinolones.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2023
    Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Treatment of Isoniazid-Resistant Pulmonary Tuberculosis.Tuberculosis and respiratory diseases · 2020
    Review
  13. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors.

Helen R StaggInstitute for Global Health, University College London, London, UK helen.stagg@ed.ac.uk.ORCID 0000-0003-4022-3447
Graham H BothamleyRespiratory Medicine, Homerton University Hospital, London, UK.ORCID 0000-0002-7092-8547
Jennifer A DavidsonTuberculosis Unit, National Infection Service, Public Health England, London, UK.
Heinke KunstBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Maeve K LalorInstitute for Global Health, University College London, London, UK.
Marc C LipmanRespiratory Medicine, Royal Free Hospital, London, UK.
Miranda G LoutetTuberculosis Unit, National Infection Service, Public Health England, London, UK.
Stefan LozewiczRespiratory Medicine, North Middlesex University Hospital, London, UK.
Tehreem MohiyuddinTuberculosis Unit, National Infection Service, Public Health England, London, UK.
Aula AbbaraInfectious Diseases, London North West University Healthcare NHS Trust, London, UK.
Eliza AlexanderNational Mycobacterial Reference Service South, Public Health England, London, UK.
Helen BoothTuberculosis Service, University College London Hospitals/Whittington Health, London, UK.
Dean D CreerRespiratory Medicine, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK.
Ross J HarrisStatistics, Modelling and Economics Department, Public Health England, London, UK.
Onn Min KonTB Service, Imperial College Healthcare, London, UK.ORCID 0000-0003-2647-4688
Michael R LoebingerRespiratory Medicine, Chelsea and Westminster Hospital, London, UK.
Timothy D McHughCentre for Clinical Microbiology, University College London, London, UK.ORCID 0000-0003-4658-8594
Heather J MilburnRespiratory Medicine, Guy's and St Thomas' Hospital, London, UK.
Paramita PalchaudhuriRespiratory Services, Queen Elizabeth Hospital, London, UK.
Patrick P J PhillipsDept of Medicine and Dept of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.ORCID 0000-0002-6336-7024
Erik SchmokRespiratory Medicine, Homerton University Hospital, London, UK.
Lucy TaylorNational Mycobacterial Reference Service South, Public Health England, London, UK.
Ibrahim AbubakarInstitute for Global Health, University College London, London, UK.
London INH-R TB study group

Funding

Department of Health PDF-2014-07-008
6 · The paper itself

Abstract

introduction2018 World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-resistant (Hr) tuberculosis recommend a four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx), with or without H ([H]RZE-Lfx). This is used once Hr is known, such that patients complete 6 months of Lfx (≥6[H]RZE-6Lfx). This cohort study assessed the impact of fluoroquinolones (Fq) on treatment effectiveness, accounting for Hr mutations and degree of phenotypic resistance.

methodsThis was a retrospective cohort study of 626 Hr tuberculosis patients notified in London, 2009-2013. Regimens were described and logistic regression undertaken of the association between regimen and negative regimen-specific outcomes (broadly, death due to tuberculosis, treatment failure or disease recurrence).

resultsOf 594 individuals with regimen information, 330 (55.6%) were treated with (H)RfZE (Rf=rifamycins) and 211 (35.5%) with (H)RfZE-Fq. The median overall treatment period was 11.9 months and median Z duration 2.1 months. In a univariable logistic regression model comparing (H)RfZE with and without Fqs, there was no difference in the odds of a negative regimen-specific outcome (baseline (H)RfZE, cluster-specific odds ratio 1.05 (95% CI 0.60-1.82), p=0.87; cluster NHS trust). Results varied minimally in a multivariable model. This odds ratio dropped (0.57, 95% CI 0.14-2.28) when Hr genotype was included, but this analysis lacked power (p=0.42).

conclusionsIn a high-income setting, we found a 12-month (H)RfZE regimen with a short Z duration to be similarly effective for Hr tuberculosis with or without a Fq. This regimen may result in fewer adverse events than the WHO recommendations.

Indexed as

AdolescentAdultAgedAntitubercular AgentsDrug Therapy, CombinationDuration of TherapyEthambutolFemaleFluoroquinolonesHumansIsoniazidLevofloxacinLogistic ModelsLondonMaleMiddle AgedAntitubercular AgentsEthambutolFluoroquinolonesIsoniazidLevofloxacinPyrazinamideRifampin

Identifiers

PMID31371444
PMCPMC6785706

What OpenQuestion holds

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LicenceCC BY-NC
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.