Abstract

Background: Effective treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis(FQr-MDR-TB) is difficult because of the limited number of available core anti-TBdrugs and high rates of resistance to anti-TB drugs other than FQs. However, few studieshave examined anti-TB drugs that are effective in treating patients with FQr-MDR-TBin a real-world setting. Methods: The impact of anti-TB drug use on treatment outcomes in patients with pulmonaryFQr-MDR-TB was retrospectively evaluated using a nationwide integrated TBdatabase (Korean Tuberculosis and Post-Tuberculosis). Data from 2011 to 2017 wereincluded. Results: The study population consisted of 1,082 patients with FQr-MDR-TB. The overalltreatment outcomes were as follows: treatment success (69.7%), death (13.7%),lost to follow-up or not evaluated (12.8%), and treatment failure (3.9%). On a propensity-score-matched multivariate logistic regression analysis, the use of bedaquiline (BDQ),linezolid (LZD), levofloxacin (LFX), cycloserine (CS), ethambutol (EMB), pyrazinamide,kanamycin (KM), prothionamide (PTO), and para-aminosalicylic acid against susceptiblestrains increased the treatment success rate (vs. unfavorable outcomes). The use ofLFX, CS, EMB, and PTO against susceptible strains decreased the mortality (vs. treatmentsuccess). Conclusion: A therapeutic regimen guided by drug-susceptibility testing can improvethe treatment of patients with pulmonary FQr-MDR-TB. In addition to core anti-TB drugs,such as BDQ and LZD, treatment of susceptible strains with later-generation FQs andKM may be beneficial for FQr-MDR-TB patients with limited treatment options.