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Antibiotic use and resistance of Streptococcus pneumoniae in The Netherlands during the period 1994-1999
A J de Neeling1, B P Overbeek, A M Horrevorts
1National Institute of Public Health and the Environment, Bilthoven. Leeuwarden, Nijmegen and Haarlem, The Netherlands. han.de.neeling@rivm.nl
Abstract:
Antibiotic use in The Netherlands during the period 1994-1999 is described in relation to the resistance of routine isolates of Streptococcus pneumoniae. The average antibiotic use in the study period was 3.4 defined daily doses per 1000 persons per day (DDD/1000/day) penicillins, 0.066 DDD/1000/day beta-lactams other than penicillins, 2.3 DDD/1000/day tetracyclines and 0.71 DDD/1000/day trimethoprim and sulphonamides, without apparent rise or decline. In contrast, the use of macrolides doubled from 0.51 DDD/1000/day in 1994 to 1.0 DDD/1000/day in 1997 and stayed at 1.07 DDD/1000/day in 1998 and 1999. In 1994 the first pneumococci isolated from patients showed 0.7% resistance to penicillin (intermediate plus full resistance), 2.5% to erythromycin, 4.2% to co-trimoxazole and 4.7% to tetracycline. In 1999 first isolates showed 1.5% resistance to penicillin, 3.8% to erythromycin, 4.4% to co-trimoxazole and 6.6% to tetracycline. The modest but significant rise in the resistance to erythromycin may have been caused by the increased use of macrolides in the years 1994-1997. The rise in resistance to penicillin seemed not to be related to increased beta-lactam use.
Insights
Antibiotic resistance in Streptococcus pneumoniae increased from 1994 to 1999 in The Netherlands. Rising macrolide use correlated with increased erythromycin resistance, while penicillin resistance rose independently of beta-lactam use.
Area of Science:
- Medical Microbiology
- Pharmacology
- Epidemiology
Background:
- Antibiotic resistance is a growing global health concern.
- Streptococcus pneumoniae is a common cause of bacterial infections.
- Monitoring antibiotic use and resistance patterns is crucial for public health.
Purpose of the Study:
- To examine the relationship between antibiotic consumption and Streptococcus pneumoniae resistance in The Netherlands between 1994 and 1999.
- To identify trends in the use of specific antibiotic classes and their impact on bacterial resistance.
Main Methods:
- Retrospective analysis of antibiotic consumption data (defined daily doses per 1000 persons per day).
- Surveillance of antibiotic resistance in routine Streptococcus pneumoniae isolates.
- Correlation analysis between antibiotic use and resistance rates.
Main Results:
- Macrolide use doubled between 1994 and 1997, remaining elevated through 1999.
- Erythromycin resistance in Streptococcus pneumoniae increased from 2.5% in 1994 to 3.8% in 1999.
- Penicillin resistance slightly increased from 0.7% to 1.5% during the study period.
- Tetracycline and co-trimoxazole resistance also showed modest increases.
Conclusions:
- Increased macrolide consumption may be linked to the rise in erythromycin resistance in Streptococcus pneumoniae.
- The observed increase in penicillin resistance was not directly associated with changes in beta-lactam antibiotic use.
- Continued surveillance of antibiotic resistance and consumption is vital.