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Resistance to erythromycin in group A streptococci
H Seppälä1, A Nissinen, H Järvinen
1Antimicrobial Research Unit, National Institute of Public Health, Turku, Finland.
The New England Journal of Medicine
|January 30, 1992
Summary
Erythromycin resistance in group A streptococci has rapidly increased in Finland, impacting treatment success for pharyngitis. This rise in antibiotic resistance poses a significant public health concern due to limited alternative oral medications.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Erythromycin use in Finland tripled between 1979 and 1989.
- An unusual rise in erythromycin resistance in group A streptococci was noted in 1988.
- A national study was initiated to assess the scope of this emerging resistance.
Purpose of the Study:
- To evaluate the extent of erythromycin resistance in group A streptococci nationally.
- To determine the clinical significance of erythromycin resistance in group A streptococcal infections.
Main Methods:
- Analysis of 272 group A streptococci isolates from blood cultures (1988-1990).
- Testing of 3087 throat swab and 1349 pus isolates from 1990 for erythromycin resistance.
- Clinical evaluation of treatment outcomes for pharyngitis patients.
Main Results:
- Erythromycin resistance in blood culture isolates rose from 4% (1988) to 24% (1990).
- Resistance in throat and pus isolates increased significantly in 1990 (7-20% and 11-31%, respectively).
- Erythromycin treatment failure occurred in 47% of patients with resistant infections versus 4% with susceptible infections (P=0.008).
Conclusions:
- A rapid and substantial increase in erythromycin resistance among group A streptococci has occurred in Finland since 1988.
- This resistance is particularly concerning given the limited availability of alternative oral antibiotics.
- The findings highlight the urgent need for monitoring and managing antibiotic resistance.