Use of Levofloxacin in Congenital Tuberculosis

BACKGROUND: Congenital tuberculosis (CTB), a serious and often fatal infection acquired in utero or during delivery, continues to pose significant challenges in treatment. METHODS: We describe 2 cases of CTB treated with levofloxacin from the inpatient department of Anhui Provincial Children's Hospital. In addition, we performed a literature review and identified 18 eligible cases from 17 published case reports of CTB treated with levofloxacin-containing antituberculosis regimens, which were reported in both Chinese and English journals. These cases were analyzed together with our patients. RESULTS: A total of 20 cases of CTB were analyzed. Of these, at least 80% (16/20) were preterm infants. The rationale for including levofloxacin in the antituberculosis regimen fell into 4 main categories: hepatic dysfunction 35% (7/20), drug resistance to first-line agents 45% (9/20), severe or disseminated disease, such as miliary tuberculosis or tuberculous meningitis 20% (4/20), and intention to avoid the ocular toxicity of ethambutol 10% (2/20). The indications were not mutually exclusive, as some patients had more than 1 reason for receiving levofloxacin. Excluding one case with unevaluable outcomes, treatment was effective in 18 of the remaining 19 cases (94.74%). Notable outcomes among responders included 1 child with mild developmental delay and hearing loss. One patient (5.26%) died. No definitive levofloxacin-associated articular cartilage damage or other severe adverse reactions were reported in any of the 18 patients. Likewise, no articular cartilage abnormalities were detected during follow-up in our 2 in-house cases. CONCLUSIONS: We suggest that levofloxacin be considered for inclusion in combination regimens for CTB under strict therapeutic drug monitoring in specific clinical scenarios. These include severe antituberculosis drug-induced liver injury, resistance to first-line agents, critical illness such as miliary or meningeal disease, and when the ocular toxicity risk of ethambutol must be avoided.