Limited Tolerability of Levofloxacin and Pyrazinamide for Multidrug-Resistant Tuberculosis Prophylaxis in a Solid Organ Transplant Population

Authors

  • Huei-Xin Lou M.S.,

    1. Department of Pharmacy, Singapore General Hospital, Singapore
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  • Michael A. Shullo Pharm.D.,

    Corresponding author
    1. Department of Pharmacy, Singapore General Hospital, Singapore
    2. Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Teresa P. McKaveney B.S.

    1. Department of Pharmacy, Singapore General Hospital, Singapore
    2. Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania
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Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 302 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213; e-mail: shulloma@msx.upmc.edu.

Abstract

Study Objective. To determine the long-term tolerability of prophylactic administration of pyrazinamide and levofloxacin in patients possibly exposed to multidrug-resistant tuberculosis (MDRTB) after undergoing solid organ transplantation.

Design. Retrospective analysis.

Setting. Community outpatient clinic.

Patients. Forty-eight recipients of solid organ transplants beginning prophylaxis for MDRTB during August 1999 after possible exposure to a single index case of multidrug-resistant Mycobacterium tuberculosis within our community.

Intervention. Prophylaxis consisted of pyrazinamide 30 mg/kg/day plus levofloxacin 500 mg/day, administered for 1 year.

Measurements and Main Results. Thirteen (27.1%) of the 48 patients completed therapy; 27 (56.3%) discontinued therapy within 4 months due to adverse drug events. Gastrointestinal intolerance was the major adverse event resulting in early discontinuation.

Conclusion. Prophylaxis of MDRTB with levofloxacin and pyrazinamide was associated with limited tolerability due to the high frequency of adverse events. While we search for a better tolerated prophylactic regimen, close monitoring for adverse reactions is recommended.

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