[Mechanisms for the development of quinolone resistance]

New fluoroquinolones have potent and broad antimicrobial activity and spectra, respectively, against gram-positive and -negative bacteria including P. aeruginosa. As a result of their frequent use, bacterial resistance to the quinolones has gradually developed and limited their therapeutic efficacy in infections, especially, with P. aeruginosa, S. pneumoniae, S. aureus (especially MRSA), and N. gonorrhoeae. Bacterial resistance to the quinolones probably results from : 1) mutations with chromosomal genes of DNA gyrase or DNA topoisomerase in E. coli and S. aureus, 2) decreased permeability of the cell envelope through OmpF, porin-forming protein, in gram-negative bacteria, and 3) activation of active efflux-mediated permeability through the cell membrane protein, either NorA in S. aureus or Opr in P. aeruginosa. Proper use of the quinolones is also proposed to prevent emergence of the bacterial resistance.