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Our prediction of levofloxacin
resistance was based partially on the behavior of ciprofloxacin with Staphylococcus
aureus. When this organism was treated with ciprofloxacin, resistance developed very
rapidly as resistant strains spread through hospitals (1). Although the selection window
hypothesis does not bear on dissemination of resistant strains, those strains had to come
from somewhere. The window hypothesis predicts that ciprofloxacin-resistant S. aureus
would arise readily because of the location of the pharmacokinetic curve relative to the
window (filled circles). Notice that data for levofloxacin with S. pneumoniae are
similar to data for ciprofloxacin and S. aureus. This correlation does not mean
that levofloxacin resistance in S. pneumoniae will develop as rapidly as
ciprofloxacin resistant S. aureus since dissemination factors are probably
different. However, this correspondence is very unsettling. |