AUTHOR=Shariati Aref , Arshadi Maniya , Khosrojerdi Mohammad Ali , Abedinzadeh Mostafa , Ganjalishahi Mahsa , Maleki Abbas , Heidary Mohsen , Khoshnood Saeed 

TITLE=The resistance mechanisms of bacteria against ciprofloxacin and new approaches for enhancing the efficacy of this antibiotic

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.1025633

DOI=10.3389/fpubh.2022.1025633

ISSN=2296-2565

ABSTRACT=Ciprofloxacin (CIP) is an antibiotic agent in the fluoroquinolone (FQ) class and is used to treat a wide variety of infections, including chronic otorrhea, endocarditis, lower respiratory tract, gastrointestinal, skin and soft tissue, and urinary tract infections for around three decades. The primary mechanism of action of CIP is the prevention of DNA replication by inhibiting the A subunit of DNA gyrase and by an additional effect on cell wall compounds. CIP attains therapeutic concentrations in most tissues and body fluids with a low potential for adverse effects and is available in intravenous and oral formulations. While this antibiotic has exceptional characteristics, over the years, CIP resistance has increased in different bacteria such as Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella typhi. The emergence of CIP-resistant pathogens indicates the need for discovering new synergisms and derivatives of this drug. To this end, combining CIP with various antibacterial agents such as antibiotics from different classes, nanoparticles, natural products, and photodynamic therapy could increase the efficacy of CIP against multi-drug resistant isolate and biofilm community of microorganisms. This review concentrates on the structure, mechanisms of action and resistance, epidemiology of resistance, synergisms, and clinical usages of CIP.