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The Bactericidal Activity of Moxifloxacin in Patients with Pulmonary Tuberculosis

Departments of Medical Microbiology and Primary Care and Population Sciences, Royal Free and University College London Medical Schools, Royal Free Campus, London, United Kingdom; Kibong'oto National Tuberculosis and Leprosy Hospital, Sanya Juu; and Clinical Laboratory, Kilimanjaro Christian Medical College, Moshi, Tanzania

Correspondence and requests for reprints should be addressed to Stephen H. Gillespie, M.D., FRCP(Edin), FRCPath, Department of Medical Microbiology, Royal Free and University London College Medical Schools, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. E-mail: stepheng{at}rfc.ucl.ac.uk

Patients in whom acid-fast bacilli smear-positive pulmonary tuberculosis was newly diagnosed were randomized to receive 400 mg moxifloxacin, 300 mg isonaizid, or 600 mg rifampin daily for 5 days. Sixteen-hour overnight sputa collections were made for the 2 days before and for 5 days of monotherapy. Bactericidal activity was estimated by the time taken to kill 50% of viable bacilli (vt₅₀) and the fall in sputum viable count during the first 2 days designated as the early bactericidal activity (EBA). The mean vt₅₀ of moxifloxacin was 0.88 days (95% confidence interval [CI], 0.43–1.33 days) and the mean EBA was 0.53 (95% CI 0.28–0.79). For the isoniazid group, the mean vt₅₀ was 0.46 days (95% CI, 0.31–0.61 days) and the mean EBA was 0.77 (95% CI, 0.54–1.00). For rifampin, the mean vt₅₀ was 0.71 days (95% CI, 0.48–0.95 days) and the mean EBA was 0.28 (95% CI, 0.15–0.41). Using the EBA method, isoniazid was significantly more active than rifampin (p < 0.01) but not moxifloxacin. Using the vt₅₀ method, isoniazid was more active than both rifampin and moxifloxacin (p = 0.03). Moxifloxacin has an activity similar to rifampin in human subjects with pulmonary tuberculosis, suggesting that it should undergo further assessment as part of a short course regimen for the treatment of drug-susceptible tuberculosis.

Key Words: clinical trials • Africa • tuberculosis • quinolone

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