title: Selection of ciprofloxacin resistance in Escherichia coli in an in vitro kinetic model: relation between drug exposure and mutant prevention concentration.
abstract: OBJECTIVE
  To evaluate the mutant prevention concentrations (MPCs) of ciprofloxacin for two susceptible and one first-step gyrA resistant mutant Escherichia coli strains in an in vitro kinetic model and to identify the pharmacodynamic index that best predicts prevention of resistance emergence.
  
  
  METHODS
  An in vitro kinetic model was used to measure MPC with static antibiotic concentrations and to test different dosing profiles to study pharmacokinetics/pharmacodynamics indices important to prevent the growth of resistant mutants. In one set of kinetic experiments the starting concentration was equal to the MPC and the T > MPC was varied before antibiotic dilution was begun. In a second set of kinetic experiments C(max) was varied and dilution of the antibiotic was started at time zero.
  
  
  RESULTS
  From the static experiments we calculated MPC values of 0.128 mg/L for both the susceptible strains (16x MIC) and 0.188 mg/L (4x MIC) for the first-step resistant (gyrA) strain. The kinetic experiments showed that the T > MPC needed to prevent the growth of resistant bacteria was shorter with an increased C(max). When resistance was selected, several subpopulations with different levels of susceptibility to ciprofloxacin emerged.
  
  
  CONCLUSIONS
  Neither T > MPC nor C(max) proved to be single correlates for preventing resistance development. For the two investigated wild-type strains, an AUC/MPC ratio of > or =22 was the single pharmacodynamic index that predicted prevention of resistant mutant development.
authors.affiliation: Antibiotic Research Unit, Department of Medical Sciences, Clinical Bacteriology and Infectious Diseases, Uppsala University, S-751 22 Uppsala, Sweden.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Olofsson
authors.forename: Linda L
authors.initials: LL
authors.lastname: Marcusson
authors.forename: Patricia
authors.initials: P
authors.lastname: Komp Lindgren
authors.forename: Diarmaid
authors.initials: D
authors.lastname: Hughes
authors.forename: Otto
authors.initials: O
authors.lastname: Cars
mesh_terms: D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D019540:Area Under Curve; D002939:Ciprofloxacin / Q000493:pharmacokinetics / Q000494:pharmacology*; D015169:Colony Count, Microbial; D027081:DNA Gyrase / Q000235:genetics; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D008954:Models, Biological; D009154:Mutation; D012641:Selection, Genetic; D014552:Urinary Tract Infections / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D027081:DNA Gyrase