Levofloxacin Preventive Therapy for Persons Exposed to MDR Tuberculosis

   This editorial discusses the emerging role of levofloxacin as preventive therapy for individuals exposed to multidrug-resistant (MDR) tuberculosis, based on findings from two randomized controlled trials: VQUIN MDR (Vietnam) and TB-CHAMP (South Africa). Both trials evaluated daily oral levofloxacin for six months versus placebo and found lower, but not statistically significant, incidence of tuberculosis in the levofloxacin groups. A prespecified meta-analysis of individual patient data showed a 60% relative reduction in cumulative incidence (P=0.03), supporting its potential efficacy. Safety profiles were acceptable, though discontinuation due to mild adverse events was higher in the levofloxacin group. The editorial emphasizes the need for fluoroquinolone resistance testing, especially given geographic variability, and highlights ongoing trials of delamanid as an alternative. It calls for clearer WHO guidance and broader implementation of chemoprevention strategies to improve tuberculosis control.

   This editorial discusses the emerging role of levofloxacin as preventive therapy for individuals exposed to multidrug-resistant (MDR) tuberculosis, based on findings from two randomized controlled trials: VQUIN MDR (Vietnam) and TB-CHAMP (South Africa). Both trials evaluated daily oral levofloxacin for six months versus placebo and found lower, but not statistically significant, incidence of tuberculosis in the levofloxacin groups. A prespecified meta-analysis of individual patient data showed a 60% relative reduction in cumulative incidence (P=0.03), supporting its potential efficacy. Safety profiles were acceptable, though discontinuation due to mild adverse events was higher in the levofloxacin group. The editorial emphasizes the need for fluoroquinolone resistance testing, especially given geographic variability, and highlights ongoing trials of delamanid as an alternative. It calls for clearer WHO guidance and broader implementation of chemoprevention strategies to improve tuberculosis control.