A Prospective Assessment of Therapeutic Efficacy and Immune Effects of Levofloxacin and Ofloxacin in Multiple-Drug Resistant Tuberculosis

Abstract

Background: Multi-drug resistant tuberculosis impairing the effectiveness of standard treatments may contribute to increased mortality. High failure and relapse rates are recorded when standard regimens are used for multi-drug resistant tuberculosis. Objective: The aim of this study was to comparatively assess the effectiveness of levofloxacin and ofloxacin in the treatment of multi-drug resistant tuberculosis; and to determine the immunological effects of treatment regimens including either levofloxacin or ofloxacin. Methods: The study was conducted among multi-drug resistant tuberculosis patients (n=40) who were randomized to receive either levofloxacin (n=18), or ofloxacin (n=22) as part of their regimen. The outcomes of MDR-TB treatment were recorded as cure, failure, default or death. The immune profile covering a range of immune markers including CD45 (total lymphocyte), CD3 (total T-lymphocyte), CD4, CD8 and CD4/CD8 ratios were assessed for 14 patients from each group both before and two months after the commencement of treatment. Results: Cure rates were 86.4% for the ofloxacin and 72.2% for the levofloxacin groups. Both groups had similar cure, treatment failure, treatment default and death rates (p>0.05; for all). When the pooled data from both groups were analyzed, CD45, CD3/CD4, CD19, CD3/CD25 (activated T cell), CD3/HLA-DR, HLA-DR and CD4/CD8 levels were found to increase in response to treatment while the CD3/CD8 level was found to decrease (p<0.05; for all). Conclusion: The results suggest that ofloxacin and levofloxacin as a part of multi-drug resistant tuberculosis treatment demonstrate similar cure rates and multi-drug resistant tuberculosis drug regimens including levofloxacin or ofloxacin may have positive immunomodulatory properties.