Reply to Tien et al Free

To the Editor—Tien et al [1] report their experience using quinolones for the treatment of latent tuberculosis infection in liver transplant candidates. Their data confirm our findings [2], which indicate that quinolone prophylaxis is associated with a high frequency of adverse effects, particularly with regard to musculoskeletal involvement. Unfortunately, they do not break down the data on the use of levofloxacin and moxifloxacin, so it is not clear whether there are differences in tolerability between the two quinolones. In their experience, which is based on clinical practice, such adverse effects do not require discontinuing treatment as often as in our clinical trial. The authors observed that it is common for patients to tolerate prophylaxis after a suspension period to improve symptoms of musculoskeletal involvement. Obviously, the use of drugs, especially suspension and reintroduction, differ markedly from clinical trials to clinical practice. In the case of a clinical trial, the criteria for the suspension and reintroduction of drugs are very strict. In this case, we are obligated to follow the standard protocol, although in clinical practice we may do otherwise.

Therefore, the experience of Tien et al [1] based on clinical practice complements our results based on a clinical trial. Moreover, it indicates that patients could tolerate the reintroduction of quinolones once the adverse effects that led to their suspension disappear.

Notes

Financial support. This work was supported by the Ayudas para el fomento de la investigacion clinica independiente [EC 10-120] and Programa Intramural CAIBER 2010. Other funding sources: National R&D&I Plan 2008–2011 and The Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI) [RD06/0008, RD12/0015], cofinanced by European Development Regional Fund “A way to achieve Europe” ERDF. CIBERehd is financed by the Instituto de Salud Carlos III (ISCIII).

Potential conflict of interest. Both authors: No reported conflicts.

Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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