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Its a precursor to NAD+, a coenzyme critical for metabolic processes

The fact that this MIC far exceeds the clinical breakpoint by several-fold to tens of folds strongly suggests that the bacterium likely produces drug-inactivating enzymes, such as aminoglycoside-modifying enzymes, which efficiently destroy antibiotic molecules, leading to high-level resistance

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79 However, the FDA revised its guidance in 2020, moving toward a risk-based approach in which the need for a cardiovascular outcome trial is determined based on the drugs characteristics, safety profile, and existing cardiovascular risk data