scholarly journals Antipneumococcal Activity of DW-224a, a New Quinolone, Compared to Those of Eight Other Agents

2006 ◽  
Vol 50 (6) ◽  
pp. 2064-2071 ◽  
Author(s):  
Klaudia Kosowska-Shick ◽  
Kim Credito ◽  
Glenn A. Pankuch ◽  
Gengrong Lin ◽  
Bülent Bozdogan ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Resistance Mechanisms ◽  
Quinolone Resistance ◽  
Penicillin G ◽  
Amoxicillin Clavulanate ◽  
Agar Dilution ◽  
Efflux Mechanism ◽  
Resistant Strains ◽  
Azithromycin Resistance

ABSTRACT DW-224a is a new broad-spectrum quinolone with excellent antipneumococcal activity. Agar dilution MIC was used to test the activity of DW-224a compared to those of penicillin, ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, gemifloxacin, amoxicillin-clavulanate, cefuroxime, and azithromycin against 353 quinolone-susceptible pneumococci. The MICs of 29 quinolone-resistant pneumococci with defined quinolone resistance mechanisms against seven quinolones and an efflux mechanism were also tested. DW-224a was the most potent quinolone against quinolone-susceptible pneumococci (MIC50, 0.016 μg/ml; MIC90, 0.03 μg/ml), followed by gemifloxacin, moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin. β-Lactam MICs rose with those of penicillin G, and azithromycin resistance was seen mainly in strains with raised penicillin G MICs. Against the 29 quinolone-resistant strains, DW-224a had the lowest MICs (0.06 to 1 μg/ml) compared to those of gemifloxacin, clinafloxacin, moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin. DW-224a at 2× MIC was bactericidal after 24 h against eight of nine strains tested. Other quinolones gave similar kill kinetics relative to higher MICs. Serial passages of nine strains in the presence of sub-MIC concentrations of DW-224a, moxifloxacin, levofloxacin, ciprofloxacin, gatifloxacin, gemifloxacin, amoxicillin-clavulanate, cefuroxime, and azithromycin were performed. DW-224a yielded resistant clones similar to moxifloxacin and gemifloxacin but also yielded lower MICs. Azithromycin selected resistant clones in three of the five parents tested. Amoxicillin-clavulanate and cefuroxime did not yield resistant clones after 50 days.

scholarly journals Antipneumococcal Activity of DK-507k, a New Quinolone, Compared with the Activities of 10 Other Agents

2003 ◽  
Vol 47 (12) ◽  
pp. 3815-3824 ◽  
Author(s):  
Frederick A. Browne ◽  
Bülent Bozdogan ◽  
Catherine Clark ◽  
Linda M. Kelly ◽  
Lois Ednie ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Quinolone Resistance ◽  
Penicillin G ◽  
Agar Dilution ◽  
Resistant Strains ◽  
Resistant Mutants ◽  
Subinhibitory Concentrations ◽  
Time Kill

ABSTRACT Agar dilution MIC determination was used to compare the activity of DK-507k with those of ciprofloxacin, levofloxacin, gatifloxacin, moxifloxacin, sitafloxacin, amoxicillin, cefuroxime, erythromycin, azithromycin, and clarithromycin against 113 penicillin-susceptible, 81 penicillin-intermediate, and 67 penicillin-resistant pneumococci (all quinolone susceptible). DK-507k and sitafloxacin had the lowest MICs of all quinolones against quinolone-susceptible strains (MIC at which 50% of isolates were inhibited [MIC50] and MIC90 of both, 0.06 and 0.125 μg/ml, respectively), followed by moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin. MICs of β-lactams and macrolides rose with those of penicillin G. Against 26 quinolone-resistant pneumococci with known resistance mechanisms, DK-507k and sitafloxacin were also the most active quinolones (MICs, 0.125 to 1.0 μg/ml), followed by moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin. Mutations in quinolone resistance-determining regions of quinolone-resistant strains were in the usual regions of the parC and gyrA genes. Time-kill testing showed that both DK-507k and sitafloxacin were bactericidal against all 12 quinolone-susceptible and -resistant strains tested at twice the MIC at 24 h. Serial broth passages in subinhibitory concentrations of 10 strains for a minimum of 14 days showed that development of resistant mutants (fourfold or greater increase in the original MIC) occurred most rapidly for ciprofloxacin, followed by moxifloxacin, DK-507k, gatifloxacin, sitafloxacin, and levofloxacin. All parent strains demonstrated a fourfold or greater increase in initial MIC in<50 days. MICs of DK-507k against resistant mutants were lowest, followed by those of sitafloxacin, moxifloxacin, gatifloxacin, ciprofloxacin, and levofloxacin. Four strains were subcultured in subinhibitory concentrations of each drug for 50 days: MICs of DK-507k against resistant mutants were lowest, followed by those of sitafloxacin, moxifloxacin, gatifloxacin, levofloxacin, and ciprofloxacin. Exposure to DK-507k and sitafloxacin resulted in mutations, mostly in gyrA.

scholarly journals MIC and time-kill studies of antipneumococcal activity of GV 118819X (sanfetrinem) compared with those of other agents.

1997 ◽  
Vol 41 (1) ◽  
pp. 148-155 ◽  
Author(s):  
S K Spangler ◽  
M R Jacobs ◽  
P C Appelbaum
Keyword(s):  
United States ◽  
The United States ◽  
Broth Microdilution ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Amoxicillin Clavulanate ◽  
Agar Dilution ◽  
Resistant Strains ◽  
Time Kill

Agar dilution MIC methodology was used to test the activities of GV 118819X (sanfetrinem), ampicillin, amoxicillin, amoxicillin-clavulanate, cefpodoxime, loracarbef, levofloxacin, clarithromycin, ceftriaxone, imipenem, and vancomycin against 53 penicillin-susceptible, 84 penicillin-intermediate and 74 penicillin-resistant pneumococci isolated in the United States. GV 118819X was the most active oral beta-lactam, with MIC at which 50% of the isolates were inhibited (MIC50)/MIC90 values of 0.008/0.03, 0.06/0.5, and 0.5/1.0 micrograms/ml against penicillin-susceptible, -intermediate, and -resistant stains, respectively. Amoxicillin and amoxicillin in the presence of clavulanate (2:1) were the second most-active oral beta-lactams, followed by ampicillin and cefpodoxime; loracarbef was not active against penicillin-intermediate and -resistant strains. Clarithromycin was most active against penicillin-susceptible strains but was less active against intermediate and resistant stains. All pneumococcal stains were inhibited by ceftriaxone and imipenem at MICs of < or = 4.0 and < or = 1.0 micrograms/ml, respectively. The activities of levofloxacin and vancomycin were unaffected by penicillin susceptibility. Time-kill studies of three penicillin-susceptible, three penicillin-intermediate, and three penicillin-resistant pneumococci showed that all compounds, at the broth microdilution MIC, yielded 99.9% killing of all strains after 24 h. Kinetic patterns of all oral beta-lactams, ceftriaxone, and vancomycin were similar relative to the MIC, with 90% killing of all strains first observed after 12 h. However, killing by amoxicillin-clavulanate, imipenem, and levofloxacin was slightly faster and that by clarithromycin was slower than that by the above-described drugs. At 2 x the MIC, more strains were killed earlier than was the case at the MIC, but the pattern seen at the MIC prevailed. When MICs and kill kinetics were combined, sanfetrinem was the most active oral antipneumococcal agent in this study.

scholarly journals Amoxicillin-Clavulanate Therapy Increases Childhood Nasal Colonization by Methicillin-Susceptible Staphylococcus aureus Strains Producing High Levels of Penicillinase

2004 ◽  
Vol 48 (12) ◽  
pp. 4618-4623 ◽  
Author(s):  
Didier Guillemot ◽  
Stephane Bonacorsi ◽  
John S. Blanchard ◽  
Philippe Weber ◽  
Sylvie Simon ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Odds Ratio ◽  
Selection Process ◽  
Nasal Carriage ◽  
Penicillin G ◽  
Nasal Colonization ◽  
Factors Associated ◽  
Amoxicillin Clavulanate ◽  
Resistant Strains

ABSTRACT We examined factors associated with penicillinase production by nasal carriage Staphylococcus aureus strains in 648 children aged 3 to 6 years attending 20 randomly sampled playschools. The children were prospectively monitored for drug use and medical events for 6 months and were then screened for S. aureus carriage. Isolates were tested for their susceptibility to penicillin G and methicillin, and penicillinase production by methicillin-susceptible, penicillin-resistant strains was quantified. S. aureus was isolated from 166 children (25.6%). Exposure to amoxicillin-clavulanate during the previous 3 months was associated with higher penicillinase production by penicillin-resistant, methicillin-susceptible strains (odds ratio, 3.6; P = 0.03). These results suggest that use of the amoxicillin-clavulanate combination could induce a herd selection process of S. aureus strains producing higher levels of penicillinase.

scholarly journals In Vitro Activity of DC-159a, a New Broad-Spectrum Fluoroquinolone, Compared with That of Other Agents against Drug-Susceptible and -Resistant Pneumococci

2007 ◽  
Vol 52 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Catherine Clark ◽  
Kathy Smith ◽  
Lois Ednie ◽  
Tatiana Bogdanovich ◽  
Bonifacio Dewasse ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
The Other ◽  
Quinolone Resistance ◽  
Vitro Activity ◽  
In Vitro Activity ◽  
Resistance Selection ◽  
Resistant Strains

ABSTRACT DC-159a yielded MICs of ≤1 μg/ml against 316 strains of both quinolone-susceptible and -resistant pneumococci (resistance was defined as a levofloxacin MIC ≥4 μg/ml). Although the MICs for DC-159a against quinolone-susceptible pneumococci were a few dilutions higher than those of gemifloxacin, the MICs of these two compounds against 28 quinolone-resistant pneumococci were identical. The DC-159a MICs against quinolone-resistant strains did not appear to depend on the number or the type of mutations in the quinolone resistance-determining region. DC-159a, as well as the other quinolones tested, was bactericidal after 24 h at 2× MIC against 11 of 12 strains tested. Two of the strains were additionally tested at 1 and 2 h, and DC-159a at 4× MIC showed significant killing as early as 2 h. Multistep resistance selection studies showed that even after 50 consecutive subcultures of 10 strains in the presence of sub-MICs, DC-159a produced only two mutants with maximum MICs of 1 μg/ml.

scholarly journals Comparative In Vitro Activities of GAR-936 against Aerobic and Anaerobic Animal and Human Bite Wound Pathogens

2000 ◽  
Vol 44 (10) ◽  
pp. 2747-2751 ◽  
Author(s):  
Ellie J. C. Goldstein ◽  
Diane M. Citron ◽  
C. Vreni Merriam ◽  
Yumi Warren ◽  
Kerin Tyrrell
Keyword(s):  
Penicillin G ◽  
Bite Wound ◽  
Coagulase Negative Staphylococci ◽  
Human Bite ◽  
Agar Dilution ◽  
Resistant Strains ◽  
Bite Wounds ◽  
Aerobic And Anaerobic ◽  
Antibacterial Spectrum

ABSTRACT GAR-936 is a new semisynthetic glycylcycline with a broad antibacterial spectrum, including tetracycline-resistant strains. The in vitro activities of GAR-936, minocycline, doxycycline, tetracycline, moxifloxacin, penicillin G, and erythromycin were determined by agar dilution methods against 268 aerobic and 148 anaerobic strains of bacteria (including Pasteurella, Eikenella,Moraxella, Bergeyella, Neisseria, EF-4, Bacteroides, Prevotella,Porphyromonas, Fusobacterium,Staphylococcus, Streptococcus,Enterococcus, Corynebacterium,Propionibacterium, Peptostreptococcus, andActinomyces) isolated from infected human and animal bite wounds in humans, including strains resistant to commonly used antimicrobials. GAR-936 was very active, with an MIC at which 90% of the strains are inhibited (MIC90) of ≤0.25 μg/ml, against all aerobic gram-positive and -negative strains, including tetracycline-resistant strains of Enterococcus,Streptococcus, and coagulase-negative staphylococci, except for Eikenella corrodens (MIC90, ≤4 μg/ml). GAR-936 was also very active against all anaerobic species, including tetracycline-, doxycycline-, and minocycline-resistant strains ofPrevotella spp., Porphyromonas spp.,Bacteroides tectum, and Peptostreptococcusspp., with an MIC90 of ≤0.25 μg/ml. Erythromycin- and moxifloxacin-resistant fusobacteria were susceptible to GAR-936, with an MIC90 of 0.06 μg/ml.

scholarly journals In Vitro Development of Resistance to Five Quinolones and Amoxicillin-Clavulanate in Streptococcus pneumoniae

1999 ◽  
Vol 43 (5) ◽  
pp. 1177-1182 ◽  
Author(s):  
Todd A. Davies ◽  
Glenn A. Pankuch ◽  
Bonifacio E. Dewasse ◽  
Michael R. Jacobs ◽  
Peter C. Appelbaum
Keyword(s):  
Streptococcus Pneumoniae ◽  
Quinolone Resistance ◽  
In Vitro Development ◽  
Development Of Resistance ◽  
Amoxicillin Clavulanate ◽  
Efflux Mechanism ◽  
High Level ◽  
Vitro Development ◽  
Selection Of

ABSTRACT The ability of 50 sequential subcultures in subinhibitory concentrations of ciprofloxacin, levofloxacin, grepafloxacin, sparfloxacin, trovafloxacin, and amoxicillin-clavulanate to select for resistance was studied for six penicillin-susceptible and four penicillin-intermediate pneumococci. Subculturing in ciprofloxacin, grepafloxacin, levofloxacin, and sparfloxacin led to selection of mutants requiring increased MICs for all 10 strains, with MICs rising from (i) 0.5 to 4.0 to (ii) 4.0 to 32.0 μg/ml after 7 to 12 passages for ciprofloxacin, from (i) 0.06 to 0.25 to (ii) 0.5 to 8.0 μg/ml after 5 to 23 passages for grepafloxacin, from (i) 0.5 to 1.0 to (ii) 4.0 to 64 μg/ml after 14 to 49 passages for levofloxacin, and from (i) 0.125 to 0.25 to (ii) 1.0 to 16.0 μg/ml after 8 to 26 passages for sparfloxacin. Subculturing in trovafloxacin led to increased MICs for eight strains, with MICs rising from (i) 0.06 to 0.125 to (ii) 0.5 to 8.0 μg/ml after 6 to 28 passages. Subculturing in amoxicillin-clavulanate led to raised MICs for only one strain, with the MIC rising from 0.015 to 0.125 μg/ml after 24 passages. Double mutations in both ParC and GyrA led to high-level quinolone resistance when ParC mutations were at S79. Trovafloxacin MICs were 1 to 2 μg/ml in double mutants with ParC mutations at positions other than S79 (e.g., D83). Mutations in ParE (at D435, R447, and E474) and GyrB (at S405, D406, and D435) were found in four and six mutants, respectively. In the presence of reserpine, 29 mutants had lower ciprofloxacin MICs (2 to 16 times lower), 8 mutants had lower levofloxacin MICs (2 times), and one mutant had a lower trovafloxacin MIC (2 times), suggesting the involvement of an efflux mechanism. In contrast to the case for quinolones, subculturing in the presence of amoxicillin-clavulanate did not select for resistance to this drug.

scholarly journals Susceptibilities of Penicillin- and Erythromycin-Susceptible and -Resistant Pneumococci to HMR 3647 (RU 66647), a New Ketolide, Compared with Susceptibilities to 17 Other Agents

1998 ◽  
Vol 42 (3) ◽  
pp. 624-630 ◽  
Author(s):  
G. A. Pankuch ◽  
M. A. Visalli ◽  
M. R. Jacobs ◽  
P. C. Appelbaum
Keyword(s):  
Bactericidal Activity ◽  
Penicillin G ◽  
Significant Activity ◽  
Agar Dilution ◽  
Resistant Strains ◽  
Kinetics Of

ABSTRACT Susceptibility of 230 penicillin- and erythromycin-susceptible and -resistant pneumococci to HMR 3647 (RU 66647), a new ketolide, was tested by agar dilution, and results were compared with those of erythromycin, azithromycin, clarithromycin, roxithromycin, rokitamycin, clindamycin, pristinamycin, ciprofloxacin, sparfloxacin, trimethoprim-sulfamethoxazole, doxycycline, chloramphenicol, cefuroxime, ceftriaxone, imipenem, and vancomycin. HMR 3647 was very active against all strains tested, with MICs at which 90% of the strains were inhibited (MIC90s) of 0.03 μg/ml for erythromycin-susceptible strains (MICs, ≤0.25 μg/ml) and 0.25 μg/ml for erythromycin-resistant strains (MICs, ≥1.0 μg/ml). All other macrolides yielded MIC90s of 0.03 to 0.25 and >64.0 μg/ml for erythromycin-susceptible and -resistant strains, respectively. The MICs of clindamycin for 51 of 100 (51%) erythromycin-resistant strains were ≤0.125 μg/ml. The MICs of pristinamycin for all strains were ≤1.0 μg/ml. The MIC90s of ciprofloxacin and sparfloxacin were 4.0 and 0.5 μg/ml, respectively, and were unaffected by penicillin or erythromycin susceptibility. Vancomycin and imipenem inhibited all strains at ≤1.0 μg/ml. The MICs of cefuroxime and cefotaxime rose with those of penicillin G. The MICs of trimethoprim-sulfamethoxazole, doxycycline, and chloramphenicol were variable but were generally higher in penicillin- and erythromycin-resistant strains. HMR 3647 had the best kill kinetics of all macrolides tested against 11 erythromycin-susceptible and -resistant strains, with uniform bactericidal activity (99.9% killing) after 24 h at two times the MIC and 99% killing of all strains at two times the MIC after 12 h for all strains. Pristinamycin showed more rapid killing at 2 to 6 h, with 99.9% killing of 10 of 11 strains after 24 h at two times the MIC. Other macrolides showed significant activity, relative to the MIC, against erythromycin-susceptible strains only.

scholarly journals Susceptibilities of 228 penicillin- and erythromycin-susceptible and -resistant pneumococci to RU 64004, a new ketolide, compared with susceptibilities to 16 other agents.

1997 ◽  
Vol 41 (5) ◽  
pp. 1033-1036 ◽  
Author(s):  
L M Ednie ◽  
S K Spangler ◽  
M R Jacobs ◽  
P C Appelbaum
Keyword(s):  
Penicillin G ◽  
Agar Dilution ◽  
Resistant Strains

The susceptibilities of 228 penicillin- and erythromycin-susceptible and -resistant pneumococci to RU 64004, a new ketolide, were tested by agar dilution, and the results were compared with those for penicillin G, erythromycin, azithromycin, clarithromycin, rokitamycin, clindamycin, pristinamycin, ciprofloxacin, sparfloxacin, trimethoprim-sulfamethoxazole, doxycycline, chloramphenicol, cefuroxime, ceftriaxone, imipenem, and vancomycin. RU 64004 was very active against all strains tested, with MICs at which 90% of the isolates are inhibited (MIC90s) of 0.016 microg/ml for erythromycin-susceptible strains (MIC, < or = 0.25 microg/ml) and 0.25 microg/ml for erythromycin-resistant strains (MIC, > or = 0.5 microg/ml). All other macrolides had MIC90s of 0.03 to 0.25 and > or = 128 microg/ml for erythromycin-susceptible and -resistant strains, respectively. Among erythromycin-resistant strains, clindamycin MICs for 28 of 91 (30.7%) were < or = 0.125 microg/ml. Pristinamycin MICs for all strains were < or = 1.0 microg/ml. MIC90s of ciprofloxacin and sparfloxacin were 4.0 and 0.25 microg/ml, respectively, and were unaffected by susceptibility to penicillin or erythromycin. Vancomycin and imipenem inhibited all strains at < or = 0.5 and < or = 0.25 microg/ml, respectively. MICs of cefuroxime and cefotaxime rose with those of penicillin G. MICs of trimethoprim-sulfamethoxazole, doxycycline, and chloramphenicol were variable but were generally higher for penicillin- and erythromycin-resistant strains. RU 64004 is the first member of the macrolide group which has low MICs for erythromycin-resistant pneumococci.

scholarly journals Activities of Ceftobiprole, a Novel Broad-Spectrum Cephalosporin, against Haemophilus influenzae and Moraxella catarrhalis

2006 ◽  
Vol 50 (6) ◽  
pp. 2050-2057 ◽  
Author(s):  
Tatiana Bogdanovich ◽  
Catherine Clark ◽  
Lois Ednie ◽  
Gengrong Lin ◽  
Kathy Smith ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Broad Spectrum ◽  
Moraxella Catarrhalis ◽  
Clinical Isolates ◽  
Phase Iii ◽  
Phase Iii Clinical Trials ◽  
Highly Active ◽  
Amoxicillin Clavulanate ◽  
Resistant Strains ◽  
Time Kill

ABSTRACT Ceftobiprole, a broad-spectrum pyrrolidinone-3-ylidenemethyl cephem currently in phase III clinical trials, had MICs between 0.008 μg/ml and 8.0 μg/ml for 321 clinical isolates of Haemophilus influenzae and between ≤0.004 μg/ml and 1.0 μg/ml for 49 clinical isolates of Moraxella catarrhalis. Ceftobiprole MIC50 and MIC90 values for H. influenzae were 0.06 μg/ml and 0.25 μg/ml for β-lactamase-positive strains (n = 262), 0.03 μg/ml and 0.25 μg/ml for β-lactamase-negative strains (n = 40), and 0.5 μg/ml and 2.0 μg/ml for β-lactamase-negative ampicillin-resistant strains (n = 19), respectively. Ceftobiprole MIC50 and MIC90 values for β-lactamase-positive M. catarrhalis strains (n = 40) were 0.12 μg/ml and 0.5 μg/ml, respectively, whereas the ceftobiprole MIC range for β-lactamase-negative M. catarrhalis strains (n = 9) was ≤0.004 to 0.03 μg/ml. Ceftriaxone MICs usually were generally at least twofold lower than those of ceftobiprole, whereas amoxicillin-clavulanate MICs usually were higher than those of ceftobiprole. Azithromycin and telithromycin had unimodal MIC distributions against H. influenzae, with MIC90 values of azithromycin and telithromycin of 2 μg/ml and 4 μg/ml, respectively. Except for selected quinolone-nonsusceptible H. influenzae strains, moxifloxacin proved highly active, with MIC90 values of 0.12 μg/ml. Time-kill analyses showed that ceftobiprole, ceftriaxone, cefpodoxime, amoxicillin-clavulanate, azithromycin, telithromycin, and moxifloxacin were bactericidal at 2× MIC by 24 h against all 10 H. influenzae strains surveyed. Only modest increases in MICs were found for H. influenzae or M. catarrhalis clones after 50 serial passages in the presence of subinhibitory concentrations of ceftobiprole, and single-passage selection showed that the selection frequency of H. influenzae or M. catarrhalis clones with elevated ceftobiprole MICs is quite low.

scholarly journals Plasmid-mediated quinolone resistance by genes qnrA1 and qnrB19 in Salmonella strains isolated in Brazil

2011 ◽  
Vol 5 (06) ◽  
pp. 496-498 ◽  
Author(s):  
Rafaela Ferrari ◽  
Antonio Galiana ◽  
Rosa Cremades ◽  
Juan Carlos Rodriguez ◽  
Marciane Magnani ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Quinolone Resistance ◽  
Poultry Production ◽  
Salmonella Spp ◽  
Mutant Selection ◽  
Microbial Resistance ◽  
Resistance Profile ◽  
Resistant Strains ◽  
Near Future ◽  
Selection Of

Considering the importance of the mechanisms involved in quinolone resistance, this study evaluate the presence of PMQR in 126 epidemic and not epidemic strains of Salmonella spp. It was noted that presence of PMQR, by itself, did not generate resistance to ciprofloxacin;  but detection of qnr genes in Salmonella spp. and the identification of the qnrB19 variant in a strain of poultry origin alert for the indiscriminate use of quinolones in poultry production, that can result in a pressure for mutant selection of resistant strains with a clinical limitation use of FQs in the near future. And last but not least, is the need to continued study of resistance mechanisms and to monitor the microbial resistance profile of epidemiological strains.

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