Table 3. Mechanisms of resistance to commonly used antimicrobials

Class Examples Mechanisms
ß-Lactams Penicillin, ampicillin, cephamycin, carbapenem   ß-Lactamases, altered penicillin-binding proteins (PBP); efflux
Aminoglycosides   Gentamicin, kanamycin, amikacin, tobramycin    Modification of antibiotic by acylation, phosphorylation, or adenylylation
Tetracyclines Tetracycline, minocycline Efflux; ribosomal protection
Chloramphenicol   Chloramphenicol   Modification of acylation
Fluoroquinolones Ciprofloxacin, enrofloxacin, sparfloxacin Mutational alteration of target (GyrA, Topo IV, Par); efflux
Macrolides Erythromycin, clarithromycin Modification of 23S RNA by methylation
Glycopeptides Vancomycin, teicoplanin   Alteration of antibiotic binding site in cell envelope
Macrolides Erythromycin, clarithromycin Modification, amplification, or substitution of target dihydropteroate synthase
Trimethoprim Trimethoprim Amplification or substitution of target dihydrofolate reductase
Ansamycin Rifamycin Mutational alteration of RNA polymerase ß-subunit; occasionally ribosylation of drug
Isoniazid Isoniazid Prevention of inactivation of pro-drug (kat) or modification of target pathway (inhA kasA)
Azoles   Ketoconazole, fluconazole Efflux; mutational alteration of lanosterol demethylase