Bioengineer.org | Rethinking TB Therapy for the Very Old: Fluoroquinolone Regimens Emerge as a Safer Bet

17 October 2026

Bioengineer.org news story

TB in the very old is one of the quiet blind spots of modern infectious disease medicine. While global control programs have focused heavily on reducing transmission in younger, more mobile populations, the fastest-growing group of patients in many TB-endemic countries is now over the age of seventy. These patients bring with them a biological landscape that is fundamentally different from that of younger adults: immune systems reshaped by immunosenescence, kidneys and livers that metabolize drugs more slowly, and a heavy burden of chronic comorbidities that complicate every therapeutic decision. A new retrospective study from Beijing Chest Hospital, Capital Medical University, published in BMC Geriatrics, argues that the standard drug cocktail used for decades to treat pulmonary TB may be poorly suited to this population, and that fluoroquinolone-containing regimens deserve a much closer look.

The study enrolled 184 newly diagnosed pulmonary TB patients aged seventy years and older in 2023. All patients were treated at a single center, and each received one of four initial TB regimens. Two of these were conventional: the standard quadruple therapy known as HR(L2)ZE, combining isoniazid, rifampicin or rifapentine, pyrazinamide, and ethambutol, and a triple therapy, HR(L2)E, which omits pyrazinamide. The other two replaced pyrazinamide with a fluoroquinolone, producing a fluoroquinolone-containing quadruple regimen and a fluoroquinolone-containing triple regimen. The researchers then compared treatment success rates and adverse event rates across the four groups, using multivariate logistic regression and propensity score matching to adjust for the inevitable baseline differences between patients who received different drugs.

Read the full news story here.

Source: Bioengineer.org