A Cochrane review included 5 trials (n=1 330) investigating antituberculous regimens based on rifampicin and pyrazinamide and containing fluoroquinolones in people with presumed drug-sensitive pulmonary tuberculosis. The duration of the examined regimens was at least 6 months. A single trial (n=174) added levofloxacin to the standard first-line regimen (HRZE). There was no statistically significant effect on death (RR 0.27, 95% CI 0.03 to 2.47), on sputum conversion at 8 weeks (RR 0.98, 95% CI 0.91 to 1.07), nor on adverse events (RR 1.0, 95% CI 0.52 to 1.92). Three trials (723 participants) substituted ethambutol with moxifloxacin, gatifloxacin, and ofloxacin into the standard first-line regimen (HRZE). There was no evidence on an effect on relapse (RR 0.71, 95% CI 0.17 to 3.06; 1 trial, n=125), death from any cause (RR 0.52, 95% CI 0.21 to 1.32), sputum culture conversion at 8 weeks RR 1.07, 95% CI 0.97 to 1.19; 3 trials, n=608), or serious adverse events (RR 0.93, 95% CI 0.53 to 1.62; 3 trials, n=723). A single trial (n=433) substituted moxifloxacin for isoniazid. There was no statistically significant effect on death (RR 0.75, 95% CI 0.17 to 3.30), sputum culture conversion (RR 1.1, 95% CI 0.91 to 1.33), or serious adverse events (RR 1.10, 95% CI 0.43 to 2.80).
11 studies with a total of 1 514 subjects. No statistically significant difference was found in trials substituting ciprofloxacin, ofloxacin or moxifloxacin for first-line drugs in relation to cure (416 participants, 3 trials), treatment failure (388 participants, 3 trials), or clinical or radiological improvement (216 participants, 2 trials). Substituting ciprofloxacin into first-line regimens in drug-sensitive tuberculosis led to a higher incidence of relapse (RR 7.17, 95% CI 1.33 to 38.58; 384 participants, 3 trials) and longer time to sputum culture conversion (WMD 0.50 months, 95% CI 0.18 to 0.82; 168 participants, 1 trial), although this was confined to HIV-positive participants. Substituting for ethambutol in first-line regimens led to a higher incidence of total number of adverse events (RR 1.34, 95% CI 1.05 to 1.72; 492 participants, 2 trials). Adding or substituting levofloxacin to basic regimens in drug-resistant areas had no effect. A comparison of sparfloxacin versus ofloxacin added to regimens showed no statistically significant difference in cure, treatment failure, or total number of adverse events.Comment: The quality of evidence is downgraded by imprecise results (few patients for each comparison) and by study limitations (selective outcome reporting, high loss to follow-up).