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The global epidemiology of resistance to ciprofloxacin and the changing nature of antibiotic resistance: a 10 year perspective.

Many studies have examined the in-vitro activity of ciprofloxacin. The results are for the most part encouraging but we must guard against complacency. Levels of ciprofloxacin resistance vary geographically, while some predictably difficult-to-treat organisms such as Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii present challenges globally. The emergence of resistance in species previously exquisitely sensitive to ciprofloxacin, such as Neisseria gonorrhoeae, in countries associated with 'pirate' production and indiscriminate use of antimicrobials represents a major challenge. Ciprofloxacin continues to show excellent activity against Haemophilus influenzae and Moraxella catharralis. In general, ciprofloxacin shows good activity against Enterobacteriaceae although the emergence of reduced susceptibility and, sometimes, quinolone resistance in multi-resistant isolates should be noted.