Antimalarial Therapy Selection for Quinolone Resistance among Escherichia coli in the Absence of Quinolone Exposure, in Tropical South America

2008

Chloroquine Use and Quinolone Resistance in E. coli

Sample size: 535 publication 10 minutes Evidence: high

Author Information

Author(s): Davidson Ross J., Davis Ian, Willey Barbara M., Rizg Keyro, Bolotin Shelly, Porter Vanessa, Polsky Jane, Daneman Nick, McGeer Allison, Yang Paul, Scolnik Dennis, Rowsell Roy, Imas Olga, Silverman Michael S.

Primary Institution: Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada

Hypothesis

The extensive use of chloroquine in tropical countries could select for fluoroquinolone resistance among E. coli despite the absence of fluoroquinolone use.

Conclusion

Chloroquine use in remote communities likely selected for ciprofloxacin resistance in E. coli, posing a public health problem.

Supporting Evidence

4.8% of patients carried ciprofloxacin-resistant E. coli with QRDR mutations despite no local availability of quinolones.
Higher prevalence of resistance was seen shortly after a Plasmodium vivax epidemic.
Chloroquine was found to inhibit the growth of E. coli in vitro.
Resistance mutations were found in E. coli associated with fluoroquinolone resistance.

Takeaway

In some remote villages, people got bacteria that resist a medicine called ciprofloxacin, even though they never used that medicine, likely because they used another medicine called chloroquine.

Methodology

Rectal swabs were collected from clinic attendees and tested for ciprofloxacin-resistant E. coli, while drinking water was analyzed for resistant bacteria and chloroquine.