Fluoroquinolones
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Prolonged clinical course of tuberculosis: 5 case reports Five patients with tuberculosis had a prolonged clinical course, and four of these patients had a delayed diagnosis, during treatment with ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin or gatifloxacin for what appeared to be common community-acquired infections. A 97-year-old woman was hospitalised with fever and anorexia. A CT scan suggested previous tuberculosis infection. She was discharged with a 14-day course of oral ciprofloxacin [dosage not stated]. The next month, she reported weight gain and improved wellbeing. However, over the following 4 months, chest x-rays showed patchy persistent densities in both lung bases, and in her right mid and upper zones. About 6 months later, she was rehospitalised with a 3-week history of chills and fever. She had been receiving oral ciprofloxacin for a urinary tract infection [dosage and duration of treatment not stated]. An examination showed basal bilateral crepitations, and a chest x-ray was consistent with bronchopneumonia. She received three doses of IV ceftriaxone, but her temperature remained increased. She started receiving oral ciprofloxacin [dosage not stated], and her fever resolved completely. She was discharged with a 4-day supply of ciprofloxacin. The following month, she reported improved appetite and wellbeing but intermittent fever. These were attributed to a urinary tract infection. Three months later, she had three more admissions over a 2-month period for cough and fever. She received treatment for infective exacerbations of bronchiectasis. She received a variety of antibacterials including ciprofloxacin [dosage not stated]. Her fever persisted. About 1 month after her last hospitalisation, a sputum sample grew Mycobacterium tuberculosis. She received antituberculosis treatment for about 8 months. Her fever resolved. A 37-year-old woman was hospitalised with an 8-month history of chronic cough with production of dark yellow sputum. During this time, she had lost 4kg and had received four courses of oral antibacterials, including ofloxacin [dosage and duration of treatment not stated]. After treatment, chest xrays had shown improvement of right lower zone infiltrates. At admission, she had a haemoglobin level of 11.4 g/dL, a platelet count of 417 x 109/L and an erythrocyte sedimentation rate of 50 mm/h. A chest x-ray revealed infiltrates in her right lower zone. She was discharged receiving oral ciprofloxacin. Sputum smears revealed acid-fast bacilli and cultured Mycobacterium tuberculosis. She started receiving antituberculars and responded well. A 62-year-old man was hospitalised with a 3-day history of chills, fever and a cough with production of yellow sputum. After 11 days, he started receiving levofloxacin [dosage not stated]. His fever subsided and he was discharged. He was readmitted with fever and chills 17 days after levofloxacin initiation; the symptoms had recurred 1 day after levofloxacin completion. He received IV ceftriaxone and clindamycin. A thorax CT scan showed multipl
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