title: Fluoroquinolone consumption and -resistance trends in Mycobacterium tuberculosis and other respiratory pathogens: Ecological antibiotic pressure and consequences in Pakistan, 2009-2015.
abstract: Fluoroquinolones (FQs) are important anti-tuberculous drugs for the treatment of multidrug-resistant (MDR) tuberculosis. Resistance to FQs leads to fewer options for treatment of tuberculosis (TB), and infection with such strains may also require longer treatment duration. Trends of resistance in Mycobacterium tuberculosis (MTB) are indicators of MTB-resistance evolution. Drivers of such resistance need to be understood and studied to inform preventive strategies.
  
  
  
  Here, we present FQ-resistance rates and trends in Pakistan from 2010 to 2015 and compare rates with FQ-consumption data and rates in other community pathogens.
  
  
  
  Our results reveal a recent decrease in FQ-resistance rates in MTB, but an increase in resistance for Haemophilus influenzae and Shigella spp. Correlation of FQ resistance with FQ consumption at the population level was weak for MTB, although strong associations were noted for H. influenzae and Shigella spp.
  
  
  
  We discuss the possible reasons for the decrease in resistance rates in TB, putative drivers of resistance other than volume of FQ consumption, and the possible impact of the National Tuberculosis Programme and drug regulatory activities.
authors.affiliation: Aga Khan University, Karachi, Pakistan. Electronic address: sadia.shakoor@aku.edu.
authors.forename: S
authors.initials: S
authors.lastname: Shakoor
authors.affiliation: National Reference Laboratory (NRL), National TB Control Programme, Pakistan.
authors.forename: S
authors.initials: S
authors.lastname: Tahseen
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: K
authors.initials: K
authors.lastname: Jabeen
authors.affiliation: National TB Control Programme, Pakistan.
authors.forename: R
authors.initials: R
authors.lastname: Fatima
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: F R
authors.initials: FR
authors.lastname: Malik
authors.affiliation: National Reference Laboratory (NRL), National TB Control Programme, Pakistan.
authors.forename: A H
authors.initials: AH
authors.lastname: Rizvi
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: R
authors.initials: R
authors.lastname: Hasan
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D024841:Fluoroquinolones / Q000494:pharmacology* / Q000627:therapeutic use*; D006193:Haemophilus influenzae / Q000187:drug effects; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D010154:Pakistan; D012760:Shigella / Q000187:drug effects
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones
keywords: Consumption; Defined daily dose; Fluoroquinolone; Resistance; Selective pressure; Tuberculosis