Bibliographic record
Abstract
Fluoroquinolones are used widely for the treatment of LRTIs. The ATS/IDSA guidelines for CAP recommended them as useful choices in many clinical scenarios especially for hospitalized patients. Concerns have been raised that using fluoroquinolones for the management of LRTIs will destroy the value of this class for use particularly in MDR-TB. Arguments center on the notion that fluoroquinolones will mask the clinical features of TB, delaying diagnosis and enhancing widespread dissemination. They further postulate that the yield of culture-negative TB will increase and that, with increasing use of fluoroquinolones, fluoroquinolone-resistant TB will become increasingly prevalent. Many patients infected with TB present with LRTI symptoms and a lung infiltrate. A brief treatment course with a fluoroquinolone rarely produces a rapid clinical recovery. Most patients with TB, even when treated appropriately, have a very slow radiographic response and often deteriorate initially. In contrast, bacterial pneumonia usually has a rapid radiographic response especially in previously healthy young adults. Studies trying to document delayed diagnosis when fluoroquinolones have been used, have been unable to mount a persuasive case. There is no evidence that patients initially treated with a fluoroquinolone are more likely to have culture-negative TB. Multiple studies to date have documented a very low rate of fluoroquinolone-resistant TB throughout the world. There has been no relationship between prior fluoroquinolone exposure and the emergence of resistance. The most persuasive relationship is between fluoroquinolone resistance and multi-drug resistance. Indian data suggest a more widespread problem exists but that may have more to do with ease of availability of all antibiotics without physician supervision in that country. If a patient presents with a clinical illness suggestive of TB, fluoroquinolones should not be used as monotherapy. But even if used in patients ultimately shown to have TB, a short exposure to a potent fluoroquinolone is unlikely to delay diagnosis or lead to the emergence of bacterial resistance.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".