Minimizing quinolone resistance: are the new agents more or less likely to cause resistance?

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Abstract
The introduction of oral antimicrobial agents with broad-spectrum activity extending to methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and other multiply antibiotic-resistant pathogens made the fluoroquinolones an attractive choice for empirical therapy for an extensive range of conditions. As a consequence there has been heavy and indiscriminate use of these agents in some centres1–6 resulting in fluoroquinolone resistance emerging more rapidly than anticipated in certain pathogens, especially those that were only marginally susceptible.3,4,7–9 With the recent releases of more potent agents such as trovafloxacin, grepafloxacin, sparfloxacin and levofloxacin, and others under development, there is now a concern that resistance to the newer agents may also develop. Two factors will be critical in determining the rate at which resistance to these agents develops—the manner in which fluoroquinolones (old and new) are used, and whether or not there are differences between the agents in their propensity to promote the development and spread of resistance.

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