A meeting of leading Asian experts in respiratory tract infections (RTIs) and tuberculosis (TB) was held on 27th July 2012, in Tokyo, Japan. This meeting brought together clinicians and researchers to shed light on the problem of achieving a balance between the optimal management of community-acquired pneumonia (CAP) and the need to avoid possible masking of TB. There has been growing concern about the potential of antimicrobials to mask the presence of TB and, consequently, delayed treatment and increased resistance. Prof. Thomas Chang-Yao Tsao, Co-Chair of the meeting noted that CAP remains one of the most common infectious diseases and a leading cause of death worldwide, highlighting the need for clear and optimal management. At the same time, TB, while a very old disease, continues to exert severe medical consequences on populations throughout the world, particularly in Asia. Prof. Shang-Jyh Kao, Co-Chair of the meeting, commented that while the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) guidelines provide clear recommendations for the management of CAP, Asian bacterial resistance patterns and the prevalence of TB in certain regions may require clinicians to tailor treatment to their own specific situations. Both Co-Chairs stressed the need for physicians to consider the presence of TB in patients presenting with pneumonia, and to undertake appropriate diagnostic investigations to ensure optimal antimicrobial therapy, advocating short duration, high-dose therapy to reduce possible resistance.
Three presentations covered the topic in great depth, first evaluating the role of fluoroquinolones in CAP, before clarifying the potential for empiric antimicrobial treatment to delay TB diagnosis, and finishing with a clear overview of the present and future role of fluoroquinolones, with reference to the issues of disease masking and bacillary resistance. The Co-Chairs noted that raising awareness of the need to achieve a balance between the management of CAP and the problem of delaying TB treatment would help improve clinical outcomes throughout Asia.