antibiotic resistance mechanisms focusing on quinolones resistance in vibrio cholerae

Context: the number of quinolone-resistant vibrio cholerae strains reported in various clinical studies is growing steadily since the 1990s. important biological conditions such as alterations of dna topoisomerases, perturbations in regard to drug entry and efflux and plasmids transferability between bacteria, are conditions that lead to the acquisition of certain power to resist quinolones dur- ing therapy. the current article aimed to review the evolution of quinolone-resistant strains of v. cholerae, the basis for quinolone mode of action against dna topoisomerases and the recent advances in the understanding of the mechanisms by which v. cholerae strains are resistant to quinolones, including chromosomal mediated resistance involving mutations in topoisomerases, chromo- somal mediated resistance resulted in response to reduced expression and/or overexpression of proteins synthesis for porins and cellular efflux pumps, respectively and plasmid mediated resistance. evidence acquisition: this systematic review utilized the research results of clinical trials.gov database, the cochrane database of systematic reviews, medline, pubmed, google and other databases to select about 67 publications on cholera and fluoroquinolones resistance mechanisms in v. cholerae. relevant publications were reviewed; findings were synthesized using a narrative method to illustrate how the treatment of cholera with quinolones as adjunct is evolved. results: through the thorough literature review, it was found that despite the progress made in the development of effective fluo- roquinolones against various enteric pathogens including v. cholerae, new concerns emerged which include the constant reports on reduced susceptibility of these drugs against v. cholerae strains endorsed with the emergence of various mechanisms of resistance. conclusions: the current systematic review emphasized on the importance of surveying the emergence of v. cholerae resistance to quinolones that may occur during adjunct treatment of cholera and also the importance of determining the genetic basis of the resistance mechanisms for future development of more promising quinolones.