Moxifloxacin versus ethambutol in the first 2 months of treatment for pulmonary tuberculosis

William J. Burman, Stefan Goldberg, John L. Johnson, Grace Muzanye, Melissa Engle, Ann W. Mosher, Shurjeel Choudhri, Charles L. Daley, Sonal S. Munsiff, Zhen Zhao, Andrew Vernon, Richard E. Chaisson

Research output: Contribution to journalArticle

Abstract

Rationale: Moxifloxacin has promising preclinical activity against Mycobacterium tuberculosis, but has not been evaluated in multidrug treatment of tuberculosis in humans. Objective: To compare the impact of moxifloxacin versus ethambutol, both in combination with isoniazid, rifampin, and pyrazinamide, on sputum culture conversion at 2mo as a measure of the potential sterilizing activity of alternate induction regimens. Methods: Adults with smear-positive pulmonary tuberculosis were randomized in a factorial design to receive moxifloxacin (400 mg) versus ethambutol given 5 d/wk versus 3 d/wk (after 2 wk of daily therapy). All doses were directly observed. Measurements: The primary endpoint was sputum culture status at 2 mo of treatment. Results: Of 336 patients enrolled, 277 (82%) were eligible for the efficacy analysis, 186 (67%) were male, 175 (63%) were enrolled at African sites, 206 (74%) had cavitation on chest radiograph, and 60 (22%) had HIV infection. Two-month cultures were negative in 71% of patients (99 of 139) treated with moxifloxacin versus 71% (98 of 138) treated with ethambutol (p = 0.97). Patients receiving moxifloxacin, however, more often had negative cultures after 4 wk of treatment. Patients treated with moxifloxacin more often reported nausea (22 vs. 9%, p = 0.002), but similar proportions completed study treatment (88 vs. 89%). Dosing frequency had little effect on 2-mo culture status or tolerability of therapy. Conclusions: The addition of moxifloxacin to isoniazid, rifampin, and pyrazinamide did not affect 2-mo sputum culture status but did show increased activity at earlier time points.

Original languageEnglish (US)
Pages (from-to)331-338
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume174
Issue number3
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Keywords

  • Efficacy
  • Moxifloxacin
  • Randomized trial
  • Toxicity
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Burman, W. J., Goldberg, S., Johnson, J. L., Muzanye, G., Engle, M., Mosher, A. W., Choudhri, S., Daley, C. L., Munsiff, S. S., Zhao, Z., Vernon, A., & Chaisson, R. E. (2006). Moxifloxacin versus ethambutol in the first 2 months of treatment for pulmonary tuberculosis. American journal of respiratory and critical care medicine, 174(3), 331-338. https://doi.org/10.1164/rccm.200603-360OC