Prolonged Ciprofloxacin Therapy Fails to Prevent Reactivation Tuberculosis

Recently, tuberculosis that is resistant to several first-line drugs (multidrug-resistant tuberculosis [MDR-TB]) has been transmitted, and it has caused symptomatic and asymptomatic latent infections. Isoniazid and rifampin are both effective as prophylaxis for symptomatic reactivation tuberculosis in individuals whose tuberculin skin tests are positive (a manifestation of latent tuberculosis). However, isoniazid therapy usually fails to prevent reactivation when the infecting strain is resistant to the agent. Other drugs, including quinolones, have been advocated for chemoprophylaxis in individuals who have been exposed to MDR-TB. We describe a case of reactivation tuberculosis in which, in our opinion, 4 years of continuous ciprofloxacin treatment, that had been used for suppression of recurrent ascending cholangitis, failed to prevent reactivation.