Efficacy and safety of fluoroquinolone-containing regimens in pulmonary tuberculosis patients aged 70 years and above: a retrospective study

Abstract Background Older patients aged 70 years and above exhibit immunosenescence, increased comorbidity burden, and high susceptibility to adverse drug reactions. The standard HRZE regimen remains controversial in this population due to the considerable toxicity of pyrazinamide (PZA). This study aimed to evaluate the efficacy and safety of fluoroquinolone (FQ)-containing triple or quadruple regimens compared with conventional standard HR(L2)ZE or HR(L2)E regimens in older pulmonary tuberculosis (PTB) patients, so as to provide evidence for individualized treatment strategies in older adults. Methods A total of 184 newly diagnosed PTB patients aged ≥ 70 years were enrolled in this single-center retrospective study in 2023. Patients were divided into four groups according to initial anti-tuberculosis regimens: standard HR(L2)ZE quadruple therapy group, HR(L2)E triple therapy group, FQ-containing quadruple group, and FQ-containing triple group. Treatment outcomes and adverse event rates were compared among groups. Multivariate logistic regression was performed to identify independent risk factors for treatment failure and adverse events. Propensity score matching (PSM) was further performed between the standard HR(L2)ZE and FQ-containing quadruple groups to minimize baseline selection bias. Results Significant differences in treatment success rates and overall adverse event rates were observed among the four groups ( P < 0.001). Compared with the standard HR(L2)ZE regimen, both FQ-containing triple and quadruple regimens achieved significantly higher treatment success rates and lower risks of treatment failure and adverse events. After adjusting for age, gender, sputum smear status, and serum albumin level, FQ- containing triple and quadruple regimens remained independently associated with improved clinical safety and efficacy. In the PSM analysis, which specifically compared the HR(L2)ZE and FQ-containing quadruple groups, HR(L2)ZE therapy was associated with a significantly higher risk of adverse events (OR = 16.87, 95% CI: 4.85–70.33, P < 0.001). Conclusion For PTB patients aged 70 years and older, the conventional HR(L2)ZE standard regimen is associated with high toxicity and limited clinical applicability. FQ-containing triple and quadruple regimens were associated with more favorable treatment outcomes, while PZA omission was associated with a lower risk of adverse events. Individualized therapeutic strategies with prudent PZA use and rational selection of fluoroquinolone-containing regimens may be considered for older patients. Given the retrospective observational design and potential selection bias, the observed associations should not be interpreted as causal relationships and require confirmation in prospective multicenter studies. Trial registration Not applicable.