{"doi":"10.1093/ofid/ofab615","title":"Increased Moxifloxacin Dosing Among Patients With Multidrug-Resistant Tuberculosis With Low-Level Resistance to Moxifloxacin Did Not Improve Treatment Outcomes in a Tertiary Care Center in Mumbai, India","abstract":"Abstract Background Mycobacterium tuberculosis (Mtb) strains resistant to isoniazid and rifampin (multidrug-resistant tuberculosis [MDR-TB]) are increasingly reported worldwide, requiring renewed focus on the nuances of drug resistance. Patients with low-level moxifloxacin resistance may benefit from higher doses, but limited clinical data on this strategy are available. Methods We conducted a 5-year observational cohort study of MDR-TB patients at a tertiary care center in India. Participants with Mtb isolates resistant to isoniazid, rifampin, and moxifloxacin (at the 0.5 µg/mL threshold) were analyzed according to receipt of high-dose moxifloxacin (600 mg daily) as part of a susceptibility-guided treatment regimen. Univariable and multivariable Cox proportional hazard models assessed the relationship between high-dose moxifloxacin and unfavorable treatment outcomes. Results Of 354 participants with MDR-TB resistant to moxifloxacin, 291 (82.2%) received high-dose moxifloxacin. The majority experienced good treatment outcomes (200 [56.5%]), which was similar between groups (56.7% vs 54.0%, P = .74). Unfavorable outcomes were associated with greater extent of radiographic disease, lower initial body mass index, and concurrent treatment with fewer drugs with confirmed phenotypic susceptibility. Treatment with high-dose moxifloxacin was not associated with improved outcomes in either unadjusted (hazard ratio [HR], 1.2 [95% confidence interval {CI}, .6–2.4]) or adjusted (HR, 0.8 [95% CI, .5–1.4]) models but was associated with joint pain (HR, 3.2 [95% CI, 1.2–8.8]). Conclusions In a large observational cohort, adding high-dose (600 mg) moxifloxacin to a drug susceptibility test–based treatment regimen for MDR-TB was associated with increased treatment-associated side effects without improving overall outcomes and should be avoided for empiric treatment of moxifloxacin-resistant MDR-TB.","journal":"Open Forum Infectious Diseases","year":2021,"id":198089,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9472,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":429953,"name":"Zarir Udwadia","orcid":"0000-0002-1830-3259","position":1,"is_corresponding":false},{"id":772699,"name":"Prerna Arora","orcid":"0009-0000-0608-1989","position":2,"is_corresponding":false},{"id":773208,"name":"Ishita Gajjar","orcid":null,"position":3,"is_corresponding":false},{"id":772700,"name":"Samridhi Sharma","orcid":"0000-0002-1167-6511","position":4,"is_corresponding":false},{"id":773209,"name":"Megha Karane","orcid":null,"position":5,"is_corresponding":false},{"id":773210,"name":"Namrata Sawant","orcid":null,"position":6,"is_corresponding":false},{"id":773211,"name":"Nisha Kharat","orcid":null,"position":7,"is_corresponding":false},{"id":503872,"name":"Alexander Blum","orcid":null,"position":8,"is_corresponding":false},{"id":326389,"name":"Shri Vijay Bala Yogendra Shivakumar","orcid":"0000-0003-0935-8423","position":9,"is_corresponding":false},{"id":326390,"name":"Akshay Gupte","orcid":"0000-0002-5179-773X","position":10,"is_corresponding":false},{"id":326403,"name":"Nikhil Gupte","orcid":"0000-0002-6688-2478","position":11,"is_corresponding":false},{"id":773212,"name":"Jai Mullerpattan","orcid":null,"position":12,"is_corresponding":false},{"id":772701,"name":"Lancelot Pinto","orcid":"0000-0002-5418-5448","position":13,"is_corresponding":false},{"id":772702,"name":"Tester F. Ashavaid","orcid":"0000-0003-0581-1171","position":14,"is_corresponding":false},{"id":326405,"name":"Amita Gupta","orcid":"0000-0001-7036-2718","position":15,"is_corresponding":false},{"id":485121,"name":"Camilla Rodrigues","orcid":"0000-0002-6105-6660","position":16,"is_corresponding":false},{"id":333923,"name":"Jeffrey A. Tornheim","orcid":"0000-0002-1566-4622","position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":null,"created_at":"2026-07-18T23:50:27.616568Z","pmid":"35097152","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}