Outpatient Use of Erythromycin: Link to Increased Erythromycin Resistance in Group A Streptococci

Abstract

Resistance to erythromycin in group A streptococci has become an important problem among outpatients in Finland. The prevention of such problems requires information about the relationship between antimicrobial consumption and antimicrobial resistance. Having found considerable variation among health authority areas in the proportions of group A streptococci resistant to erythromycin, we investigated the potential impact of local differences in the consumption of this agent on the development of resistance. In 1992, 10,162 group A streptococcal isolates (nearly 100% were from outpatients) collected from 206 health authority areas were tested for erythromycin resistance; 1,647 isolates (16%) were resistant. Logistic regression analysis showed that the proportion of isolates resistant to erythromycin clearly increased with increasing local erythromycin consumption by outpatients in 1991 (P = .006). This positive association indicates that a prudent policy for the treatment of outpatients is essential to maintenance of the effectiveness of antimicrobial agents.

Resistance Determinants and Clonal Diversity in Group A Streptococci Collected during a Period of Increasing Macrolide Resistance

“…Results of these studies overall revealed a remarkable variability of resistance rates at different times and in different epidemiological settings (for examples, see references 1, 8, 9, 11, 25, 31, 37, and 41). A clear relationship between resistance rates and the extent of macrolide usage in community medicine was also demonstrated, with relatively rapid variations of the former in response to modifications of prescription policies (6,11,30,31).Recently, increased macrolide resistance rates in clinical isolates of S. pyogenes have been reported in several countries (1,6,8,25). This phenomenon, which likely reflects the vast popularity of the last generation of macrolides (such as azithromycin, clarithromycin, and roxithromycin) in community medicine, is a cause of considerable concern for antimicrobial chemotherapy.…”

Antibiotic Susceptibility of Streptococcus Pyogenes Strains Isolated From Throat Cultures of Children With Tonsillopharyngitis

“…During the past three decades, numerous reports have demonstrated a significant prevalence of erythromycin resistant S. pyogenes around the world (4-10). Furthermore, several reports have demonstrated that the increase in the incidence of erythromycin resistant S. pyogenes strains is related to increased macrolide consumption in the community (22)(23)(24)(25)(26). Macrolide antibiotics, especially new ones such as clarithromycin and azithromycin, are widely selected for the treatment of upper respiratory tract infections such as sore throat in our country.…”

National Department of Defense Surveillance Data for Antibiotic Resistance and emm Gene Types of Clinical Group A Streptococcal Isolates from Eight Basic Training Military Sites

“…Due to the observed erythromycin resistance rate, antibiotic prophylaxis among the recruits at the training sites was examined. No apparent correlation with erythromycin resistance and a history of erythromycin use at the sites was noted; however, other researchers have shown the reality of this concern (10,25).…”