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Comparison 1 Fluoroquinolone substituted into regimen, Outcome 1 Cure (sputum culture conversion) at 8 weeks.
Figures and Tables -
Analysis 1.1

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 1 Cure (sputum culture conversion) at 8 weeks.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 2 Treatment failure at 12 months.
Figures and Tables -
Analysis 1.2

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 2 Treatment failure at 12 months.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 3 Relapse.
Figures and Tables -
Analysis 1.3

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 3 Relapse.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 4 Relapse: by HIV status.
Figures and Tables -
Analysis 1.4

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 4 Relapse: by HIV status.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 5 Time to sputum culture conversion (months).
Figures and Tables -
Analysis 1.5

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 5 Time to sputum culture conversion (months).

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 6 Time to sputum culture conversion (months): by HIV status.
Figures and Tables -
Analysis 1.6

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 6 Time to sputum culture conversion (months): by HIV status.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 7 Clinical or radiological improvement at 8 weeks.
Figures and Tables -
Analysis 1.7

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 7 Clinical or radiological improvement at 8 weeks.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 8 Serious adverse events.
Figures and Tables -
Analysis 1.8

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 8 Serious adverse events.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 9 Total number of adverse events.
Figures and Tables -
Analysis 1.9

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 9 Total number of adverse events.

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 10 Total number of adverse events, substitutions for ethambutol.
Figures and Tables -
Analysis 1.10

Comparison 1 Fluoroquinolone substituted into regimen, Outcome 10 Total number of adverse events, substitutions for ethambutol.

Comparison 2 Fluoroquinolone added to regimen, Outcome 1 Cure (sputum culture conversion) at 8 weeks.
Figures and Tables -
Analysis 2.1

Comparison 2 Fluoroquinolone added to regimen, Outcome 1 Cure (sputum culture conversion) at 8 weeks.

Comparison 2 Fluoroquinolone added to regimen, Outcome 2 Treatment failure at 12 months.
Figures and Tables -
Analysis 2.2

Comparison 2 Fluoroquinolone added to regimen, Outcome 2 Treatment failure at 12 months.

Comparison 2 Fluoroquinolone added to regimen, Outcome 3 Clinical or radiological improvement at 8 weeks.
Figures and Tables -
Analysis 2.3

Comparison 2 Fluoroquinolone added to regimen, Outcome 3 Clinical or radiological improvement at 8 weeks.

Comparison 2 Fluoroquinolone added to regimen, Outcome 4 Death from any cause.
Figures and Tables -
Analysis 2.4

Comparison 2 Fluoroquinolone added to regimen, Outcome 4 Death from any cause.

Comparison 2 Fluoroquinolone added to regimen, Outcome 5 Tuberculosis‐related death.
Figures and Tables -
Analysis 2.5

Comparison 2 Fluoroquinolone added to regimen, Outcome 5 Tuberculosis‐related death.

Comparison 2 Fluoroquinolone added to regimen, Outcome 6 Serious adverse events.
Figures and Tables -
Analysis 2.6

Comparison 2 Fluoroquinolone added to regimen, Outcome 6 Serious adverse events.

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 1 Cure (sputum culture conversion) within 2 to 3 weeks.
Figures and Tables -
Analysis 3.1

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 1 Cure (sputum culture conversion) within 2 to 3 weeks.

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 2 Treatment failure at 12 months.
Figures and Tables -
Analysis 3.2

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 2 Treatment failure at 12 months.

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 3 Clinical or radiological improvement at 8 weeks.
Figures and Tables -
Analysis 3.3

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 3 Clinical or radiological improvement at 8 weeks.

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 4 Total number of adverse events.
Figures and Tables -
Analysis 3.4

Comparison 3 Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen, Outcome 4 Total number of adverse events.

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 1 Cure (sputum culture conversion within 2 to 3 weeks).
Figures and Tables -
Analysis 4.1

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 1 Cure (sputum culture conversion within 2 to 3 weeks).

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 2 Treatment failure at 12 months.
Figures and Tables -
Analysis 4.2

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 2 Treatment failure at 12 months.

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 3 Clinical or radiological improvement at 8 weeks.
Figures and Tables -
Analysis 4.3

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 3 Clinical or radiological improvement at 8 weeks.

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 4 Total number of adverse events.
Figures and Tables -
Analysis 4.4

Comparison 4 Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens, Outcome 4 Total number of adverse events.

Table 1. Highest multiple‐drug‐resistant tuberculosis (MDR‐TB) rates in 1998a

Location

New case

Previously treated case

Estonia

14.1

18.1

Henan Province, China

10.8

15.1

Latvia

9.0

12.0

Ivanovo Oblast, Russian Federation

9.0

12.3

Tomsk Oblast, Russian Federation

6.5

13.7

aSource: Loddenkemper 2002.

Figures and Tables -
Table 1. Highest multiple‐drug‐resistant tuberculosis (MDR‐TB) rates in 1998a
Table 2. Risk of bias assessment

Trial

Allocation sequence generation

Allocation concealment

Blinding

Inclusiona

Burman 2006

Unclear

Unclear

Unclear

Inadequate

El‐Sadr 1998

Adequate

Unclear

Assessors only

Adequate for 8 weeks
Inadequate for continuation phase (39% lost)

Huang 2000

Unclear

Unclear

Unclear

Adequate

Ji 2001

Unclear

Unclear

Unclear

Adequate

Kennedy 1993

Unclear

Unclear

None

Adequate

Kennedy 1996

Adequate

Adequate

Assessors only

Adequate

Kohno 1992

Unclear

Unclear

Unclear

Inadequate

Lu 2000

Adequate

Unclear

Participants: yes
Providers and assessors: unclear

Adequate

Mohanty 1993

Unclear

Unclear

Providers, participants, and radiograph assessors: yes

Inadequate

Saigal 2001

Adequate

Unclear

None

Adequate

Sun 2000

Unclear

Unclear

Unclear

Adequate

aInclusion of all randomized participants in the final analysis.

Figures and Tables -
Table 2. Risk of bias assessment
Comparison 1. Fluoroquinolone substituted into regimen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure (sputum culture conversion) at 8 weeks Show forest plot

3

416

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.82, 1.17]

1.1 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.88, 1.32]

1.2 Ciprofloxacin vs ethambutol plus pyrazinamide

1

20

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.42, 1.09]

1.3 Moxifloxacin vs ethambutol

1

336

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.83, 1.19]

2 Treatment failure at 12 months Show forest plot

3

388

Risk Ratio (M‐H, Fixed, 95% CI)

2.14 [0.71, 6.42]

2.1 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.83]

2.2 Ciprofloxacin vs ethambutol plus pyrazinamide

2

328

Risk Ratio (M‐H, Fixed, 95% CI)

2.03 [0.63, 6.58]

3 Relapse Show forest plot

3

384

Risk Ratio (M‐H, Fixed, 95% CI)

7.17 [1.33, 38.58]

3.1 Ciprofloxacin vs ethambutol plus pyrazinamide

1

168

Risk Ratio (M‐H, Fixed, 95% CI)

15.72 [0.91, 270.96]

3.2 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.33, 27.23]

3.3 Ofloxacin vs ethambutol

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Relapse: by HIV status Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 HIV‐positive participants: ciprofloxacin vs ethambutol plus pyrazinamide

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 HIV‐negative participants: ciprofloxacin vs ethambutol plus pyrazinamide

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Time to sputum culture conversion (months) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 Ciprofloxacin vs ethambutol plus pyrazinamide

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Time to sputum culture conversion (months): by HIV status Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 HIV‐positive participants: ciprofloxacin vs ethambutol plus pyrazinamide

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 HIV‐negative participants: ciprofloxacin vs ethambutol plus pyrazinamide

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Clinical or radiological improvement at 8 weeks Show forest plot

2

216

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.49, 1.59]

7.1 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Random, 95% CI)

1.08 [0.88, 1.32]

7.2 Ofloxacin vs ethambutol

1

156

Risk Ratio (M‐H, Random, 95% CI)

0.69 [0.44, 1.08]

8 Serious adverse events Show forest plot

5

743

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.56, 1.72]

8.1 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.26]

8.2 Ofloxacin vs ethambutol

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.47, 3.57]

8.3 Ciprofloxacin vs ethambutol plus pyrazinamide

1

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.20, 4.69]

8.4 Ofloxacin vs rifampicin

1

31

Risk Ratio (M‐H, Fixed, 95% CI)

0.10 [0.01, 1.79]

8.5 Moxifloxacin vs ethambutol

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.50, 3.05]

9 Total number of adverse events Show forest plot

4

712

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.96, 1.43]

9.1 Ciprofloxacin vs rifampicin

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.22, 4.56]

9.2 Ciprofloxacin vs ethambutol plus pyrazinamide

1

160

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.60, 1.24]

9.3 Ofloxacin vs ethambutol

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.95 [0.70, 5.44]

9.4 Moxifloxacin vs ethambutol

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.00, 1.66]

10 Total number of adverse events, substitutions for ethambutol Show forest plot

2

492

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [1.05, 1.72]

Figures and Tables -
Comparison 1. Fluoroquinolone substituted into regimen
Comparison 2. Fluoroquinolone added to regimen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure (sputum culture conversion) at 8 weeks Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Treatment failure at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Clinical or radiological improvement at 8 weeks Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Death from any cause Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Tuberculosis‐related death Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Serious adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Levofloxacin vs no levofloxacin

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Fluoroquinolone added to regimen
Comparison 3. Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure (sputum culture conversion) within 2 to 3 weeks Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Treatment failure at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Clinical or radiological improvement at 8 weeks Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Total number of adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 3. Comparison of fluoroquinolones (levofloxacin vs ofloxacin) substituted into regimen
Comparison 4. Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cure (sputum culture conversion within 2 to 3 weeks) Show forest plot

2

184

Risk Ratio (M‐H, Random, 95% CI)

2.10 [0.77, 5.71]

2 Treatment failure at 12 months Show forest plot

2

149

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.26, 1.47]

3 Clinical or radiological improvement at 8 weeks Show forest plot

3

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.92, 1.24]

4 Total number of adverse events Show forest plot

3

253

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.59, 1.64]

Figures and Tables -
Comparison 4. Comparison of fluoroquinolones (sparfloxacin vs ofloxacin) added to regimens