E-DRUG: Mofloxacin evidence in TB
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Dear colleagues,
I am deeply disappointed by the "evidence" presented allegedly
showing "superior" anti-tb activity by Bayer's Nth me-too
fluoroquinolone, mofloxacin. There is some evidence that another
quinolone, ofloxacin, has some activity in tuberculosis, but that was
not good enough for the WHO list of essential medicines. The site of
the "tb alliance" not suprisingly links to a website showing a
beautiful young lady shaking hands with an impeccably clad manager
over the Bayer emblem - not very encouraging if you are coughing your
lungs out in a smoky hut in the African bush. That only proves that
this E-mail has been written by somebody who has never treated or
even seen a patient suffering from pulmonary tuberculosis and
probably has never made or seen a Ziehl-Neelsen smear. The "evidence"
then refers to two studies in mice, a flawed Indian trial, an
abstract which is no longer available on the web, a biased editorial
(no hard data) and a kind of unpublished report written as propaganda
material. So far as I know the only "Western" country where
mofloxacin is registered is New Zealand (full datasheet available on
the web, www.medsafe.govt.nz/profs/datasheet/a/aveloxtab.htm ), but
there is no mention of Mycobaterium tuberculosis as sensitive
organism. There is a wide range of unknowns (safety in children,
pregnancy, lactation, heart disease (QT prolongation possible), and
almost all of the more or less serious side effects of the congeners,
like arrythmias, many different drug interactions, pseudomembranous
colitis, dizziness and provocation of seizures, taste perversion, all
possible g.i. reactions and disturbed liver function).
Such unfounded propaganda only raises false expectations and cannot
be condoned. After what happened to their statin Bayer should be more
careful with their me-too's. Let them present a few well monitored
large scale WHO sponsored comparative trials and then we can form an
opinion. It is now far too early.
Best wishes from a physician who in the past has treated severe cases
of tuberculosis (including Americans entering Europe without health checks).
Leo Offerhaus
offerhausl@euronet.nl