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Antimicrobial Agents and Chemotherapy, December 2000, p. 3351-3356, Vol. 44, No. 12
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Antibacterial Spectrum of a Novel Des-Fluoro(6)
Quinolone, BMS-284756
Joan C.
Fung-Tomc,*
Beatrice
Minassian,
Benjamin
Kolek,
Elizabeth
Huczko,
Lauren
Aleksunes,
Terry
Stickle,
Thomas
Washo,
Elizabeth
Gradelski,
Lourdes
Valera, and
Daniel P.
Bonner
Department of Microbiology, Bristol-Myers
Squibb Company, Wallingford, Connecticut 06492
Received 23 June 2000/Returned for modification 3 August
2000/Accepted 21 September 2000
 |
ABSTRACT |
The in vitro spectrum of a novel des-fluoro(6) quinolone,
BMS-284756, was compared with those of five fluoroquinolones
(trovafloxacin, moxifloxacin, levofloxacin, ofloxacin, and
ciprofloxacin). BMS-284756 was among the most active and often was the
most active quinolone against staphylococci (including
methicillin-resistant strains), streptococci, pneumococci (including
ciprofloxacin-nonsusceptible and penicillin-resistant strains), and
Enterococcus faecalis. BMS-284756 inhibited
60 to
70% of the Enterococcus faecium (including vancomycin-resistant) strains and 90 to 100% of the
Enterobacteriaceae strains and gastroenteric bacillary
pathogens at the anticipated MIC susceptible breakpoint (
4 µg/ml).
Against the nonfermenters, BMS-284756 inhibited 90 to 100% of
Pseudomonas fluorescens, Pseudomonas stutzeri,
Stenotrophomonas maltophilia, Flavobacterium
spp., and Acinetobacter spp. and 72% of
Pseudomonas aeruginosa strains at 4 µg/ml. Against
anaerobic bacteria, BMS-284756 was among the most
active, inhibiting essentially all strains tested. It had very low MICs
against the fastidious and atypical microbial species, in particular
against mycoplasmas or ureaplasmas, Borrelia burgdorferi, chlamydia, and gonococci. These results indicate that with its broad
antibacterial spectrum, BMS-284756 should be evaluated clinically for
the treatment of community and nosocomial infections.
 |
INTRODUCTION |
BMS-284756 is a novel
des-fluoro(6) quinolone. This means that BMS-284756 differs from
recently approved quinolones (i.e., the fluoroquinolones included in
this study and gatifloxacin) in that BMS-284756 lacks a fluorine at the
C-6 position. BMS-284756 (also known as T-3811ME) has
antibacterial activity similar to those of fluorinated quinolones, but
the des-F(6) derivatives are less acutely toxic in mice (K. Hayashi, Y. Todo, S. Hamamoto, K. Ojima, M. Yamada, T. Kito, M. Takahata, Y. Watanbe, and H. Narita, Abstr. 37th Intersci. Conf.
Antimicrob. Agents Chemother., abstr. F-158, 1997).
Quinolones can differ in their antibacterial spectra and potencies.
Notable potency differences among quinolones occur in their
activities versus gram-positive bacteria, pseudomonads, anaerobic bacteria, and mycobacteria. In the present study, the antibacterial spectrum of BMS-284756 is compared to those of five fluoroquinolones against 1,150 strains representing 66 bacterial species. While the antibacterial activity of BMS-284756 was reported previously by Takahata et al. (9), the present study
included additional bacterial species and was performed using
NCCLS-recommended susceptibility test methods, whenever
they were available for specific bacterial groups.
 |
MATERIALS AND METHODS |
Antimicrobial agents.
BMS-284756 was obtained from Toyama
Chemical Co. Ltd., Toyama, Japan, and moxifloxacin (MFX) and
ciprofloxacin (CIP) were obtained from Bayer Corporation,
West Haven, Conn. Levofloxacin (LVX) and trovafloxacin (TVA) were
extracted and purified from commercially available tablets and were
determined to be
95% pure by high-performance liquid chromatography.
Ofloxacin (OFX) was purchased from Sigma Chemical Co., St. Louis, Mo.
Bacterial strains.
All bacterial strains used in this study
were clinical isolates obtained from numerous sources of broad
geographical distribution. Isolates were maintained frozen in
liquid nitrogen. Some of the quinolone-resistant Neisseria
gonorrhoeae strains were provided by Ronald Jones (University
of Iowa, Iowa City).
Methicillin-susceptible (MS) Staphylococcus aureus was
defined as strains for which oxacillin MICs were
2 µg/ml, and MS
strains of Staphylococcus epidermidis and
Staphylococcus haemolyticus were defined as strains for
which oxacillin MICs were
0.25 µg/ml (4).
Methicillin-resistant (MR) S. aureus strains were strains for which oxacillin MICs were
4 µg/ml, and MR S. epidermidis and S. haemolyticus strains were strains
for which oxacillin MICs were
0.5 µg/ml. Because the oxacillin MIC
interpretative breakpoint does not correlate with mecA
carriage in Staphylococcus saprophyticus (2), MS
and MR categorization in this species was based on mecA
detection by PCR testing. All of the S. saprophyticus
strains in this study were mecA negative.
Growth inhibitory activity.
Determinations of the MICs for
aerobic and anaerobic bacteria were performed by an agar dilution
method in accordance with the procedure outlined by the NCCLS (4,
5). Other testing protocols used in this study were similar to
those previously reported (1), with the following
exceptions. Anaerobic bacterial susceptibility testing was done using
brucella blood agar (5), Chlamydia pneumoniae
with Hep-2 cells, and Borrelia burgdorferi with BSK H medium (Sigma).
The respective interpretative MIC breakpoints for strains susceptible,
intermediate, and resistant to the quinolones are as follows: for TVA,
2, 4, and
8 µg/ml for general organisms (FDA-approved breakpoints), but
1, 2, and
4 µg/ml for Streptococcus
pneumoniae and other streptococci (NCCLS-approved breakpoints),
and
0.25 µg/ml for gonococci (susceptible breakpoint only); for
MFX
2, 4, and
8 µg/ml for general organisms (FDA-approved
breakpoints), but
1, 2, and
4 µg/ml for Streptococcus
pneumoniae, with no interpretative MFX breakpoints for gonococci;
for LVX and OFX,
2, 4, and
8 µg/ml for all organism groups
(NCCLS-approved breakpoints), but for OFX only,
0.25, 0.5 to 1, and
2 µg/ml for gonococci; and for CIP,
1, 2, and
4 µg/ml for
general organisms (NCCLS approved), with no
interpretative criteria for Streptococcus pneumoniae and
other streptococci, and
0.06, 0.12 to 0.5, and
1 µg/ml for gonococci (2).
The respective susceptible, intermediate, and resistant breakpoints
used in the BMS-284756 clinical trials for this quinolone are
4, 8, and
16 µg/ml for the general organisms,
2, 4, and
8 µg/ml for
MR S. aureus, and
2 (susceptible breakpoint only) for
gonococci. The proposed
4-µg/ml susceptible breakpoint for BMS-284756 was based on a mean area under the curve (AUC) from 0 to
infinity of 84.1 µg · h/ml following a single 400-mg oral dose
of BMS-284756 (D. Gajjar, D. Grasela, A. Bello, Z. Ge, L. Christopher,
Abstr. 40th Intersci. Conf. Antimicrob. Agents Chemother., abstr 2259, 2000); this breakpoint is compared to the susceptible breakpoints of
quinolones (TVA, MFX, LVX, and OFX) of
2 µg/ml and AUCs of 30 to 50 µg · h/ml (3a) following a single standard dose.
For quinolones, the pharmacodynamic parameter most predictive of
efficacy is the AUC/MIC ratio (6, 8). In this paper,
4
µg/ml was used as a point of reference in discussing the BMS-284756 MIC data.
 |
RESULTS AND DISCUSSION |
All of the results discussed in this section are listed in
Table
1.
Gram-positive aerobic bacteria.
BMS-284756 was the most active
quinolone against MS and MR staphylococci. BMS-284756 was generally
2-fold more active than TVA and MFX and 8- to 32-fold more active than
LVX, OFX, and CIP. The quinolones inhibited MS staphylococci uniformly,
with MICs at which 50% of the isolated were inhibited
(MIC50s) and MIC90s generally being equal. By
comparison, the quinolone MIC ranges were broader for MR staphylococci,
with MIC50s and MIC90s differing by 32- to
64-fold. The fact that quinolone resistance is more commonly
encountered among MR than MS staphylococcal clinical isolates accounts
for the higher quinolone MIC90s for MR strains (3,
7). In fact, for 40 to 50% of MR strains tested, CIP MICs were
2 µg/ml, compared with 0% of MS strains. For all the MR S. aureus strains, BMS-284756 MICs were
2 µg/ml.
The quinolones can be grouped by their streptococcal and pneumococcal
potencies. BMS-284756, TVA, and MFX were about 10-fold more active than
LVX, OFX, and CIP against these organisms. Along with BMS-284756
(MIC90s = 0.12 to 0.25 µg/ml), LVX, TVA, and MFX covered all the streptococci and pneumococci at their susceptible breakpoints, but only BMS-284756 covered all Streptococcus
pneumoniae strains with CIP MICs of
2 µg/ml (85% of which had
OFX MICs of
4 µg/ml), and for 90% of the latter isolates
BMS-284756 MICs were
0.5 µg/ml. As with streptococci, the
enterococci were more susceptible to BMS-284756, TVA, and MFX than to
LVX, OFX, and CIP. The quinolones were more active against
Enterococcus faecalis than to Enterococcus
faecium, the latter being more frequently resistant to quinolones.
While BMS-284756, TVA, MFX, and LVX covered
90% or more of the
E. faecalis and VanC enterococcal species (i.e.,
Enterococcus gallinarum and Enterococcus
casseliflavus), only BMS-284756 covered >50% of E. faecium and VanA and VanB strains (comprised primarily of E. faecium) at
4 µg/ml.
Gram-negative aerobic bacteria.
The quinolones have good
activities against Enterobacteriaceae. Overall, CIP was the
most active against Enterobacteriaceae, except
Providencia spp. BMS-284756 was less active
against the Enterobacteriaceae, but for almost all of the
Enterobacteriaceae strains, BMS-284756 MICs were
4
µg/ml, levels that are achievable in plasma for this quinolone.
For bacterial species associated with gastroenteritis
(Salmonella spp., Shigella spp., Yersinia
enterocolitica, Aeromonas hydrophila, Vibrio
cholerae, and Campylobacter jejuni), all the quinolones
showed potent and generally similar activities.
Nonfermentative bacteria.
Pseudomonal susceptibility to the
quinolones is species dependent. Against Pseudomonas
aeruginosa, CIP remained the most active. Approximately 90% of
the P. aeruginosa strains were susceptible to CIP, TVA, and
LVX, 72% were susceptible to OFX and BMS-284756 (at
4 µg/ml), and
28% were susceptible to MFX. All Pseudomonas stutzeri
strains were susceptible to the six quinolones tested. All of the
Pseudomonas fluorescens strains were susceptible to LVX, compared to the 87 to 93% of strains that were susceptible to CIP, TVA MFX, and BMS-284756 (at
4 µg/ml) and 67% that were susceptible to OFX.
In contrast, CIP was among the least active quinolones
against the pseudomonas-related species, being inactive against
Burkholderia cepacia, Stenotrophomonas
maltophilia, and other nonfermenters (Flavobacterium and Acinetobacter spp.). While
BMS-284756 MIC90s for Stenotrophomonas
maltophilia, Flavobacterium spp.,
and Acinetobacter spp. were
4 µg/ml,
Burkholderia cepacia and Alcaligenes spp. were generally resistant.
Anaerobic bacteria.
The broadest antianaerobic bacterial
spectra were observed with BMS-284756, TVA, and MFX. BMS-284756
was very active against anaerobic bacteria, inhibiting all but one
peptostreptococcal strain at 4 µg/ml.
Fastidious bacterial species.
BMS-284756's exceptional
antigonococcal activity extended to all CIP-nonsusceptible
strains. Though the quinolones inhibited all CIP-susceptible N. gonorrhoeae strains, the BMS-284756 MIC90 for
CIP-nonsusceptible isolates was
0.25 µg/ml. While TVA was 10-fold
more active than BMS-284756 against CIP-susceptible gonococci, the
BMS-284756 MIC90 for CIP-nonsusceptible strains was 2-fold better than that of TVA.
The quinolones were very active (MIC90s,
0.1
µg/ml) against Neisseria meningitidis,
Haemophilus influenzae, Moraxella
catarrhalis, and Legionella spp., with good
activities (MIC90s,
0.5 µg/ml) also against
Bordetella spp. and Helicobacter pylori.
Included in the quinolones' spectra were all strains of
Gardnerella vaginalis (except CIP),
Mycoplasma pneumoniae (except CIP), and
Bartonella spp. (except CIP and OFX). Only BMS-284756 and
TVA inhibited all B. burgdorferi strains, with BMS-284756
MICs being 16-fold better than those of MFX, LVX, OFX, and CIP against
the Lyme disease spirochete. BMS-284756, TVA, and MFX inhibited all
Mycoplasma hominis and Ureaplasma
urealyticum strains tested, with MIC90s 10- to
100-fold better than those of LVX, OFX, and CIP against M. hominis and up to 30-fold better against U. urealyticum. This des-F(6) quinolone was the most active
against chlamydia, with all strains being inhibited at
0.016
µg/ml; BMS-284756 was 100- to 1,000-fold more active than OFX and
CIP, 50-fold more potent than LVX, and 10- to 50-fold better than MFX
against chlamydia.
Of the quinolones tested, MFX was the most active against mycobacteria
and CIP was the least active. BMS-284756 was comparable to OFX
(MIC90, 2 µg/ml) against Mycobacterium
tuberculosis. BMS-284756 was previously reported to have good
antitubercular activity, with a MIC90 of 0.06 µg/ml
(9). In the present study, the MIC90 of
BMS-284756 against M. tuberculosis was 2 µg/ml. The
difference in these MIC90 results against M. tuberculosis is likely due to susceptibility test differences. A
broth macrodilution method was used in this study, whereas Takahata et
al. (9) used a broth microdilution assay. Nevertheless, both
studies concluded that the antitubercular activities of BMS-284756 and
OFX are comparable. A recent study (E. J. Alvirez-Froitex and
M. H. Cynamon, 9th Int. Congr. Infect. Dis., Abstr. 75.015, 2000),
testing seven M. tuberculosis strains by a broth
macrodilution test, yielded modal MICs of 1 µg/ml for BMS-284756
versus 0.5 and 0.06 µg/ml for LVX and MFX, respectively.
In summary, BMS-284756 is among the most active quinolones tested
against gram-positive bacteria, particularly against MR S. aureus, S. epidermidis, and CIP-resistant S. pneumoniae. BMS-284756 had the broadest antianaerobic bacterial
coverage, inhibiting almost all of the anaerobic bacterial
strains tested. BMS-284756 was the most active quinolone against
fastidious microbes (mycoplasmas, ureaplasmas, chlamydiae,
CIP-nonsusceptible gonococci, and B. burgdorferi). It is
active against the Enterobacteriaceae and most
nonfermenters. The wide antibacterial spectrum of BMS-284756 supports
its development for a broad range of indications.
 |
FOOTNOTES |
*
Corresponding author. Mailing address:
Bristol-Myers Squibb Company, Department of Microbiology-104, 5 Research Pkwy., Wallingford, CT 06492. Phone: (203) 677-6370. Fax:
(203) 677-6771. E-mail: fungtomj{at}bms.com.
 |
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Antimicrobial Agents and Chemotherapy, December 2000, p. 3351-3356, Vol. 44, No. 12
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
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Rodriguez-Cerrato, V., McCoig, C. C., Saavedra, J., Barton, T., Michelow, I. C., Hardy, R. D., Bowlware, K., Iglehart, J., Katz, K., McCracken, G. H. Jr
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47: 211-215
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Lister, P. D.
(2003). Impact of AUC/MIC ratios on the pharmacodynamics of the des-F(6) quinolone garenoxacin (BMS-284756) is similar to other fluoroquinolones. J Antimicrob Chemother
51: 199-202
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Goldstein, E. J. C., Citron, D. M., Merriam, C. V., Warren, Y. A., Tyrrell, K. L., Fernandez, H. T.
(2002). In Vitro Activities of Garenoxacin (BMS 284756) against 108 Clinical Isolates of Gardnerella vaginalis. Antimicrob. Agents Chemother.
46: 3995-3996
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Ince, D., Zhang, X., Silver, L. C., Hooper, D. C.
(2002). Dual Targeting of DNA Gyrase and Topoisomerase IV: Target Interactions of Garenoxacin (BMS-284756, T-3811ME), a New Desfluoroquinolone. Antimicrob. Agents Chemother.
46: 3370-3380
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Snydman, D. R., Jacobus, N. V., McDermott, L. A., Ruthazer, R., Goldstein, E., Finegold, S., Harrell, L., Hecht, D. W., Jenkins, S., Pierson, C., Venezia, R., Rihs, J., Gorbach, S. L.
(2002). In Vitro Activities of Newer Quinolones against Bacteroides Group Organisms. Antimicrob. Agents Chemother.
46: 3276-3279
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Donati, M., Pollini, G. M., Sparacino, M., Fortugno, M. T., Laghi, E., Cevenini, R.
(2002). Comparative in vitro activity of garenoxacin against Chlamydia spp.. J Antimicrob Chemother
50: 407-410
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Goldstein, E. J. C., Citron, D. M., Merriam, C. V., Warren, Y. A., Tyrrell, K. L., Fernandez, H. T.
(2002). In Vitro Activities of Garenoxacin (BMS-284756) against 170 Clinical Isolates of Nine Pasteurella Species. Antimicrob. Agents Chemother.
46: 3068-3070
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Jones, M. E., Critchley, I. A., Karlowsky, J. A., Blosser-Middleton, R. S., Schmitz, F.-J., Thornsberry, C., Sahm, D. F.
(2002). In Vitro Activities of Novel Nonfluorinated Quinolones PGE 9262932 and PGE 9509924 against Clinical Isolates of Staphylococcus aureus and Streptococcus pneumoniae with Defined Mutations in DNA Gyrase and Topoisomerase IV. Antimicrob. Agents Chemother.
46: 1651-1657
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Gordon, K. A., Pfaller, M. A., Jones, R. N., the SENTRY Participants Group,
(2002). BMS284756 (formerly T-3811, a des-fluoroquinolone) potency and spectrum tested against over 10 000 bacterial bloodstream infection isolates from the SENTRY antimicrobial surveillance programme (2000). J Antimicrob Chemother
49: 851-855
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Schmitz, F.-J., Milatovic, D., Boos, M., Mayer, S., Fluit, A. C.
(2002). In vitro activity of the novel des-F(6) quinolone BMS-284756 against genetically characterized clinical streptococcal isolates, including isolates with reduced quinolone susceptibility. J Antimicrob Chemother
49: 698-701
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Low, D. E., Muller, M., Duncan, C. L., Willey, B. M., de Azavedo, J. C., McGeer, A., Kreiswirth, B. N., Pong-Porter, S., Bast, D. J.
(2002). Activity of BMS-284756, a Novel Des-Fluoro(6) Quinolone, against Staphylococcus aureus, Including Contributions of Mutations to Quinolone Resistance. Antimicrob. Agents Chemother.
46: 1119-1121
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Goldstein, E. J. C., Citron, D. M., Merriam, C. V., Warren, Y. A., Tyrrell, K. L., Fernandez, H.
(2002). In Vitro Activities of the Des-Fluoro(6) Quinolone BMS-284756 against Aerobic and Anaerobic Pathogens Isolated from Skin and Soft Tissue Animal and Human Bite Wound Infections. Antimicrob. Agents Chemother.
46: 866-870
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Schmitz, F.-J., Boos, M., Mayer, S., Kohrer, K., Scheuring, S., C. Fluit, A.
(2002). In Vitro Activities of Novel Des-Fluoro(6) Quinolone BMS-284756 against Mutants of Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus Selected with Different Quinolones. Antimicrob. Agents Chemother.
46: 934-935
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Schmitz, F.-J., Boos, M., Mayer, S., Jagusch, H., Fluit, A. C.
(2002). Increased in vitro activity of the novel des-fluoro(6) quinolone BMS-284756 against genetically defined clinical isolates of Staphylococcus aureus. J Antimicrob Chemother
49: 283-287
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Lawrence, L. E., Frosco, M., Ryan, B., Chaniewski, S., Yang, H., Hooper, D. C., Barrett, J. F.
(2002). Bactericidal Activities of BMS-284756, a Novel Des-F(6)-Quinolone, against Staphylococcus aureus Strains with Topoisomerase Mutations. Antimicrob. Agents Chemother.
46: 191-195
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Bassetti, M., Dembry, L. M., Farrel, P. A., Callan, D. A., Andriole, V. T.
(2002). Antimicrobial Activities of BMS-284756 Compared with Those of Fluoroquinolones and {beta}-Lactams against Gram-Positive Clinical Isolates. Antimicrob. Agents Chemother.
46: 234-238
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Wise, R., Gee, T., Marshall, G., Andrews, J. M.
(2002). Single-Dose Pharmacokinetics and Penetration of BMS 284756 into an Inflammatory Exudate. Antimicrob. Agents Chemother.
46: 242-244
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Pankuch, G. A., Nagai, K., Davies, T. A., Jacobs, M. R., Appelbaum, P. C.
(2002). Antipneumococcal Activity of BMS 284756 Compared to Those of Six Other Agents. Antimicrob. Agents Chemother.
46: 251-254
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Weller, T. M. A., Andrews, J. M., Jevons, G., Wise, R.
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49: 177-184
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Wu, P., Lawrence, L. E., Denbleyker, K. L., Barrett, J. F.
(2001). Mechanism of Action of the Des-F(6) Quinolone BMS-284756 Measured by Supercoiling Inhibition and Cleavable Complex Assays. Antimicrob. Agents Chemother.
45: 3660-3662
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Rodriguez-Cerrato, V., Ghaffar, F., Saavedra, J., Michelow, I. C., Hardy, R. D., Iglehart, J., Olsen, K., McCracken, G. H. Jr.
(2001). BMS-284756 in Experimental Cephalosporin-Resistant Pneumococcal Meningitis. Antimicrob. Agents Chemother.
45: 3098-3103
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Discotto, L. F., Lawrence, L. E., Denbleyker, K. L., Barrett, J. F.
(2001). Staphylococcus aureus Mutants Selected by BMS-284756. Antimicrob. Agents Chemother.
45: 3273-3275
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Fung-Tomc, J., Valera, L., Minassian, B., Bonner, D., Gradelski, E.
(2001). Activity of the novel des-fluoro(6) quinolone BMS-284756 against methicillin-susceptible and -resistant staphylococci. J Antimicrob Chemother
48: 735-738
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Schmitz, F.-J., Boos, M., Jagusch, H., Mayer, S., Fluit, A. C., Hafner, D.
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48: 588-590
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Hartman-Neumann, S., DenBleyker, K., Pelosi, L. A., Lawrence, L. E., Barrett, J. F., Dougherty, T. J.
(2001). Selection and Genetic Characterization of Streptococcus pneumoniae Mutants Resistant to the Des-F(6) Quinolone BMS-284756. Antimicrob. Agents Chemother.
45: 2865-2870
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Boswell, F. J., Andrews, J. M., Wise, R.
(2001). Comparison of the in vitro activities of BMS-284756 and four fluoroquinolones against Streptococcus pneumoniae. J Antimicrob Chemother
48: 446-447
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Lawrence, L. E., Wu, P., Fan, L., Gouveia, K. E., Card, A., Casperson, M., Denbleyker, K., Barrett, J. F.
(2001). The inhibition and selectivity of bacterial topoisomerases by BMS-284756 and its analogues. J Antimicrob Chemother
48: 195-201
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