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Mechanism of resistance • mutations to DNA gyrase, efflux pumps which reduce intracellular quinolone concentration Adverse effects • lower seizure threshold in patients with epilepsy • tendon damage (including rupture) - the risk is increased in patients also taking steroids • cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children • lengthens QT interval Q-123 One of your elderly patients is admitted to hospital with