Fluoroquinolones: is there a different mechanism of action and resistance against Streptococcus pneumoniae?
Abstract
Starting in the 1950s, study and elucidation of the biochemical mechanisms of resistance to antibiotics led to the understanding of both the biology of bacteria and the mode of action of antibiotics. This holds true for the relationship between Streptococcus pneumoniae and the fluoroquinolones. A new feature in this approach is the availability of the nearly complete chromosome sequence of this major human pathogen. In S. pneumoniae, resistance appears to be mainly due to mutational alterations in the intracellular targets of the fluoroquinolones, the type II DNA topoisomerase gyrase and topoisomerase IV. Both enzymes appear to be the primary targets of the drugs in this species. Mutations in the quinolone resistance-determining region (QRDR) of the gyrA gene or the parC gene, which encode the A subunits of DNA gyrase and topoisomerase IV respectively, confer resistance to single-step mutants. Mutations in gyrB and parE, which encode the B subunits of DNA gyrase and topo IV, respectively, have also been implicated in the fluoroquinolone resistance of certain mutants obtained in vitro. The antibiotics most affected by a single mutation are those for which the mutation occurs in their preferred target e.g. gyrase for sparfloxacin and gatifloxacin and topo IV for ciprofloxacin and levofloxacin. The activity of all fluoroquinolones is decreased further when two or more mutations are present. Because they possess similar targets of action, there is cross resistance, albeit at…
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