Fluoroquinolones: Action and resistance

被引:231
作者
Drlica, K [1 ]
Malik, M [1 ]
机构
[1] Publ Hlth Res Inst, Newark, NJ 07103 USA
关键词
gyrase; topoisomerase IV; resistance; mutant prevention concentration; moxifloxacin; gatifloxacin; levofloxacin;
D O I
10.2174/1568026033452537
中图分类号
R914 [药物化学];
学科分类号
100701 ;
摘要
Fluoroquinolones trap gyrase and topoisomerase IV on DNA as ternary complexes that block the movement of replication forks and transcription complexes. 71, Studies with resistant mutants indicate that during complex formation quinolones bind to a surface alpha-helix of the GyrA and ParC proteins. Lethal action is a distinct event that is proposed to arise from release of DNA breaks from the ternary complexes. Many bacterial pathogens are exhibiting resistance due to alterations in drug permeability, drug efflux, gyrase-protecting proteins, and target topoisomerases. When selection of resistant mutants is described in terms of fluoroquinolone concentration, a threshold (mutant prevention concentration, MPC) can be defined for restricting the development of resistance. MPC varies among fluoroquinolones and pathogens; when combined with pharmacokinetics, MPC can be used to identify compounds least likely to enrich mutant subpopulations. Use of suboptimal doses and compounds erodes the efficacy of the class as a whole because resistance to one quinolone reduces susceptibility to others and/or increases the frequency at which resistance develops. When using fluoroquinolones in combination therapy, the development of resistance may be minimized by optimizing regimens for pharmacokinetic overlap.
引用
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页码:249 / 282
页数:34
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