Levofloxacin based non‐rifampicin anti‐tuberculous therapy: An effective alternative in renal transplant recipients in resource limited setting

• DOI: 10.1111/nep.13816
• Publication Date: 2020-11-06T06:43:54Z
• Authors: Krishan Lal Gupta; Sahil Bagai; Harsha Kumar; Saurabh Nayak; Valliappan Muthu; Vivek Kumar; Manish Rathi; Harbir S Kohli; Ashish Sharma; Raja Ramachandran
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Adolescent; Remission Induction; Antitubercular Agents; India; Levofloxacin; Middle Aged; Opportunistic Infections; Kidney Transplantation; Drug Costs; 3. Good health; Immunocompromised Host; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Developing Countries; Immunosuppressive Agents; Aged; Retrospective Studies

Rifampicin is one of the most effective components anti-tuberculous therapy (ATT). Since rifampicin a hepatic enzyme (CYP3A4) inducer, in post-renal transplant recipient, dose calcineurin inhibitors needs to be up-regulated and frequently monitored. In resource-limited (low- lower-middle-income countries) setting this not always feasible. Therefore, we evaluated non-rifampicin-based ATT using levofloxacin kidney recipients.We retrospectively studied medical records renal recipients diagnosed with tuberculosis our institute between 2014 2017. After brief discussion patients regarding nature course ATT, those who opted for non-rifampicin based due financial constraints were included study followed minimum 6 months period after completion ATT.Out 550 recipients, 67 (12.2%) developed median 24 (1-228) following transplantation, them, 64 ATT. The mean age was 37.6 years. Only 25% given anti-thymocyte globulin induction, while majority (56; 87.5%) them on tacrolimus-based triple-drug maintenance therapy. Extrapulmonary noted 33% cases, 12 (18.7%) had disseminated disease. duration treatment cure rate 93.7% (n = 60) achieved at end therapy.Levofloxacin appears safe alternative cannot afford heightened tacrolimus dosage.