MONDAY, March 24 (HealthDay News) -- The use of fluoroquinones
to treat children with multidrug-resistant tuberculosis can lead to
the development of drug-resistant invasive pneumococcal disease,
including severe pneumonia and meningitis.
That finding emerged from a study by researchers at the National
Institute for Communicable Diseases in South Africa.
They analyzed 21,521 cases of children with invasive
pneumococcal disease and screened 19,404 isolates (90 percent of
all cases) for resistance to ofloxacin (a fluoroquinone). Minimum
inhibitory concentrations (MIC) for all isolates were measured, and
levofloxacin resistance was defined as an MIC of 4mg/L or more. The
researchers assessed nose and throat pneumococcal carriage in 65
children in two TB hospitals where invasive pneumococcal disease
caused by levofloxacin-resistant
Streptococcus pneumoniae had been detected.
Twelve cases of invasive pneumococcal disease were identified as
levofloxacin-resistant, all in children younger than 15 years old.
There were five deaths among the 11 patients whose outcomes were
known.
The researchers found that invasive pneumococcal disease caused
by levofloxacin-resistant
S. pneumoniae was associated with a history of TB treatment.
Eight out of nine (89 percent) children with non-susceptible
isolates had a history of TB treatment, compared to 396 of 2,202
(18 percent) of children with susceptible isolates. Among the
hospitalized children with nose and throat pneumococcal carriage,
nearly 100 percent of the bacteria were levofloxacin resistant.
"Our data suggest that the use of fluoroquinones to treat
multidrug-resistant tuberculosis in children has led to the
emergence of invasive pneumococcal diseases caused by
levofloxacin-non-susceptible
S. pneumoniae and its nosocomial spread among children," the
researchers concluded.
The study was published by
The Lancet and released Monday to coincide with World TB
Day.
More information
The U.S. National Foundation for Infectious Diseases has more
about
pneumococcal disease.
