A 78-year-old male smoker with severe chronic obstructive pulmonary disease ("COPD”) (FEV1 48% predicted) was admitted to Accident & Emergency ("A & E") department for the fourth time within 12 months. He presented to A & E with high fever (39.5°C), increased productive cough with expectoration of yellow sputum and shortness of breath. Upon admission, chest X-ray showed lung consolidation. From his previous medical record, the doctor noticed the detection of Pseudomonas aeruginosa in his prior admission. Both ciprofloxacin and gentamicin with good antipseudomonal activity have been used in this patient. 

(a) Which classes of antibiotics do ciprofloxacin and gentamicin belong to? (2 marks) 

(b) Describe the mechanisms of action for ciprofloxacin and gentamicin. (6 marks) 

(c) List TWO common adverse effects for ciprofloxacin and gentamicin respectively. (4 marks) 

(d) Name TWO mechanisms of resistance which may develop with ciprofloxacin and gentamicin respectively. (4 marks) 

(e) State FOUR reasons for the increase in prevalence of antibiotic resistance over the years. (4 marks)