Fluoroquinolones for TB preventive treatment of contacts exposed to persons with multidrug-resistant TB: a systematic review and meta-analysis.

BACKGROUND

We evaluated the safety, acceptability, and cost-effectiveness of all published studies on fluoroquinolone (FQ)-based TB preventive treatment (TPT) regimens in all settings and populations.

METHODS

We searched for studies published between February 2014 and September 2023 using PubMed, Embase, Turning Research Into Practice (TRIP), Global Health Library, and the Cochrane Central Register of Controlled Trials. Meta-analysis was conducted using random effects models.

RESULTS

Twenty-two observational and modelling studies evaluating FQ-based TPT were included, assessing outcomes of safety (n = 16), acceptability (n = 9), and cost-effectiveness (n = 2). Only 2% (95% confidence interval [CI]: 0%-4%) of children and adolescents and 8% (95% CI: 2%-14%) of adults discontinued FQ monotherapy due to drug-related adverse events (AEs). Compared to FQ monotherapy, rates of drug-related AEs of any severity were non-significantly higher with multidrug FQ regimens without pyrazinamide (PZA). Pooled discontinuation rates were 50% (95% CI: 34%-67%) among children and 57% (95% CI: 16%-98%) among adult contacts treated with PZA-containing FQ-based regimens. Pooled acceptance rates exceeded 80% among all groups. FQ-based TPT was cost-effective to avert TB-related deaths and loss of quality-adjusted life-years.

CONCLUSION

These results complement the evidence from two recent randomised trials. FQ monotherapy is a safe, acceptable, and cost-effective TPT regimen for contacts exposed to multidrug-resistant or rifampicin-resistant TB disease.