Abstract
We report a case of acquired fluoroquinolone (FQ) resistance under short-course multidrug-resistant tuberculosis (MDR-TB) treatment. The patient was managed at Kabutare hospital, one of the two specialized MDR-TB clinics in Rwanda. A low dose of moxifloxacin was used in the first three critical months. Acquired resistance was identified at the ninth month of treatment, 3 months after stopping kanamycin in a strain initially susceptible only to FQs, kanamycin, and clofazimine. Fluoroquinolone resistance was detected in the same month by deep sequencing as routinely used second-line line probe assay and phenotypic drug susceptibility testing. High-dose FQ, preferably gatifloxacin, should be used to maximize effectiveness.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
MeSH terms
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Antitubercular Agents / therapeutic use
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Clofazimine / therapeutic use
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Drug Resistance, Multiple, Bacterial / drug effects
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Drug Resistance, Multiple, Bacterial / genetics
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Female
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Fluoroquinolones / therapeutic use*
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Gatifloxacin / therapeutic use
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Genes, Bacterial
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High-Throughput Nucleotide Sequencing
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Humans
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Kanamycin / therapeutic use
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Microbial Sensitivity Tests
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Middle Aged
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Moxifloxacin / therapeutic use
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Mycobacterium tuberculosis / drug effects*
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Mycobacterium tuberculosis / genetics
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Rwanda
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Sequence Analysis, DNA
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Tuberculosis, Multidrug-Resistant / drug therapy*
Substances
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Antitubercular Agents
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Fluoroquinolones
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Kanamycin
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Clofazimine
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Gatifloxacin
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Moxifloxacin