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Streptococcus pyogenes resistance to erythromycin in relation to macrolide consumption in Spain (1986-1997)
J J Granizo1, L Aguilar, J Casal
1Research Area, Fundación Jiménez Díaz, Madrid, Spain.
Abstract:
The relationship between Streptococcus pyogenes resistance to erythromycin and macrolide consumption in Spain was studied. Erythromycin resistance was highly correlated with the consumption of total macrolides (r = 0.88, P<0.01). When macrolides were grouped into posological subgroups according to their pharmacokinetic and pharmacodynamic properties and analysed separately, erythromycin resistance appeared to be related mainly to those macrolides taken twice daily (bd) (r = 0.86, P<0.01) and those taken once daily (od) (r = 0.87, P<0.01), but not to those taken four (qds) or three times a day (tds) (r = -0.04, P: = 0.90). A progressive increase in the erythromycin resistance curve was seen after the consecutive introduction of both bd and od macrolides, which contributed to the increase in the total macrolide consumption, replacing tds macrolide prescription. Although this ecological analysis cannot establish an unequivocal causal relationship between antibiotic consumption and S. pyogenes resistance, the data are consistent with the hypothesis that widespread use of macrolides, mainly of bd and od macrolides, resulted in an increased prevalence of S. pyogenes resistant to erythromycin in Spain.
Insights
Increased macrolide antibiotic use, particularly those taken once or twice daily, is linked to higher Streptococcus pyogenes resistance to erythromycin in Spain. This study highlights the impact of antibiotic prescribing patterns on bacterial resistance.
Area of Science:
- Microbiology
- Pharmacology
- Epidemiology
Background:
- Streptococcus pyogenes is a significant human pathogen.
- Macrolide antibiotics are commonly prescribed for bacterial infections.
- Antibiotic resistance is a growing global health concern.
Purpose of the Study:
- To investigate the correlation between macrolide consumption and erythromycin resistance in Streptococcus pyogenes in Spain.
- To determine if specific macrolide dosing frequencies are associated with increased resistance.
Main Methods:
- Ecological analysis of Streptococcus pyogenes erythromycin resistance data.
- Correlation analysis between macrolide consumption (total and by posological subgroups) and resistance rates.
- Examination of trends in macrolide prescription patterns over time.
Main Results:
- A strong positive correlation was observed between total macrolide consumption and erythromycin resistance (r = 0.88, P<0.01).
- Resistance was primarily associated with macrolides administered once daily (od) (r = 0.87) and twice daily (bd) (r = 0.86), but not with those taken three or four times daily (tds/qds).
- The introduction of bd and od macrolides coincided with increased total macrolide consumption and a rise in erythromycin resistance.
Conclusions:
- The widespread use of macrolides, especially those with od and bd dosing, is consistent with the increased prevalence of erythromycin-resistant Streptococcus pyogenes in Spain.
- While causality cannot be definitively established, the findings suggest a link between specific macrolide prescribing habits and the development of antibiotic resistance.