Preincubation of Pneumococci with β-Lactams Alone or Combined with Levofloxacin Prevents Quinolone-Induced Resistance without Increasing Intracellular Levels of Levofloxacin

Preincubation of pneumococci with sub-MIC concentrations of ceftriaxone (1/16× MIC), cefotaxime (1/8× MIC), and meropenem (1/4× MIC) alone or combined with levofloxacin (1/8× MIC) over 6 h prevents the emergence of levofloxacin-resistant mutants after 96 h of incubation but does not affect the intracellular accumulation of levofloxacin in two penicillin-resistant pneumococcal strains, suggesting a link between the mechanism of action of β-lactams and the emergence of quinolone-induced resistance in pneumococci.