Suxia Ouyang, Tingxuan Huang, Chang Wang, Shun Wang, Le Zhang, Jie Ding, Yanxin Wang, Yuanyuan Xu
We suggest that levofloxacin be considered for inclusion in combination regimens for CTB under strict therapeutic drug monitoring in specific clinical scenarios. These include severe antituberculosis drug-induced liver injury, resistance to first-line agents, critical illness such as miliary or meningeal disease, and when the ocular toxicity risk of ethambutol must be avoided.
BACKGROUND: Congenital tuberculosis (CTB), a serious and often fatal infection acquired in utero or during delivery, continues to pose significant challenges in treatment.
METHODS: We describe 2 cases of CTB treated with levofloxacin from the inpatient department of Anhui Provincial Children's Hospital. In addition, we performed a literature review and identified 18 eligible cases from 17 published case reports of CTB treated with levofloxacin-containing antituberculosis regimens, which were reported in both Chinese and English journals. These cases were analyzed together with our patients.
RESULTS: A total of 20 cases of CTB were analyzed. Of these, at least 80% (16/20) were preterm infants. The rationale for including levofloxacin in the antituberculosis regimen fell into 4 main categories: hepatic dysfunction 35% (7/20), drug resistance to first-line agents 45% (9/20), severe or disseminated disease, such as miliary tuberculosis or tuberculous meningitis 20% (4/20), and intention to avoid the ocular toxicity of ethambutol 10% (2/20). The indications were not mutually exclusive, as some patients had more than 1 reason for receiving levofloxacin. Excluding one case with unevaluable outcomes, treatment was effective in 18 of the remaining 19 cases (94.74%). Notable outcomes among responders included 1 child with mild developmental delay and hearing loss. One patient (5.26%) died. No definitive levofloxacin-associated articular cartilage damage or other severe adverse reactions were reported in any of the 18 patients. Likewise, no articular cartilage abnormalities were detected during follow-up in our 2 in-house cases.
CONCLUSIONS: We suggest that levofloxacin be considered for inclusion in combination regimens for CTB under strict therapeutic drug monitoring in specific clinical scenarios. These include severe antituberculosis drug-induced liver injury, resistance to first-line agents, critical illness such as miliary or meningeal disease, and when the ocular toxicity risk of ethambutol must be avoided.