Macrolide resistance rates in respiratory pathogens in Slovenia following reduced macrolide use

• Published in: International journal of antimicrobial agents Vol. 28; no. 6; pp. 537 - 542
• Main Authors: Čižman, Milan, Beović, Bojana, Seme, Katja, Paragi, Metka, Štrumbelj, Iztok, Müller-Premru, Manica, Čad-Pečar, Silva, Pokorn, Marko
• Format: Journal Article
• Language: English
• Published: London Elsevier B.V 01.12.2006; Amsterdam Elsevier; New York, NY
• Subjects: Adolescent; Adult; Ambulatory Care; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic consumption; Antibiotic resistance; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteria - drug effects; Biological and medical sciences; Child; Child, Preschool; Drug Resistance, Bacterial; General aspects; Haemophilus influenzae - drug effects; Humans; Macrolides; Macrolides - pharmacology; Macrolides - therapeutic use; Medical sciences; Moraxella (Branhamella) catarrhalis - drug effects; Pharmacology. Drug treatments; Prevalence; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Slovenia - epidemiology; Streptococcus pneumoniae - drug effects; Streptococcus pyogenes - drug effects; Europe; Slovenia; Macrolides; Antibiotic consumption; Antibiotic resistance; Consumption; Nutrition; Respiratory system; Macrolide; Resistance; Respiratory tract; Antibiotic; Diet; Pathogenic; Protein synthesis inhibitor; Antibacterial agent
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2006.07.023

The aim of this study was to investigate the association between decreased use of macrolides and resistance of common respiratory pathogens in Slovenia from 1999 to 2004. Over a 6-year period the consumption of macrolides in Slovenia decreased by 21.3%, from 3.81 defined daily doses/1000 inhabitants per day (DID) to 3.0 DID. The use of short-acting, intermediate-acting and long-acting subclasses of macrolides decreased by 50%, 18% and 13%, respectively. In the same period, resistance of invasive strains of Streptococcus pneumoniae increased from 4.6% to 11.1% and resistance of non-invasive strains of S. pneumoniae and Streptococcus pyogenes increased from 12.8% to 20.2% and from 7.4% to 12.5%, respectively. Resistance increased significantly more in children than in adults ( P = 0.05) and was significantly correlated with increased use of intermediate-acting macrolides ( r = 0.94 for non-invasive S. pneumoniae and r = 0.96 for S. pyogenes) in children. Resistance of Haemophilus influenzae and Moraxella catarrhalis was low and did not change. In children and adults, the emergence and spread of multidrug-resistant strains of invasive S. pneumoniae was observed. The decline in total macrolide use was not paralleled by reduced macrolide resistance rates of S. pyogenes and S. pneumoniae during the 6-year period. There was a strong correlation between the use of intermediate-acting macrolides and macrolide resistance of S. pyogenes and S. pneumoniae in children. Further reduction in the use of intermediate- and long-acting macrolides should be encouraged.