Development of resistance to nalidixic acid and the fluoroquinolones after the introduction of norfloxacin and ofloxacin.

Since 1975, the group Resistenz of the Paul-Ehrlich-Gesellschaft für Chemotherapie has monitored the development of resistance in isolates of members of the family Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis in the Federal Republic of Germany, West Berlin, Austria, and Switzerland. Despite a marked increase in the use of 4-quinolones, there was no increase in the percentages of nalidixic acid-resistant strains of Enterobacteriaceae between 1975 and 1986. However, different bacterial species showed considerable variation, and there were also considerable differences in the percentages of nalidixic acid-resistant strains of Enterobacteriaceae from different centers. The frequency of resistance to fluoroquinolones was unchanged from 1983 to 1986 and was less than 4% in all species except P. aeruginosa. In this species, there was an increase from about 3 to 10% from 1983 to 1986 for strains for which the MIC was fourfold above the mode MIC of ciprofloxacin, enoxacin, and ofloxacin.