title: Macrolide resistance mechanisms in Gram-positive cocci.
abstract: Two principal mechanisms of resistance to macrolides have been identified in Gram-positive bacteria. Erythromycin-resistant methylase is encoded by erm genes. Resultant structural changes to rRNA prevent macrolide binding and allow synthesis of bacterial proteins to continue. Presence of the erm gene results in high-level resistance. Modification of the mechanism whereby antibiotics are eliminated from the bacteria also brings about resistance. Bacteria carrying the gene encoding macrolide efflux (i.e. the mefE gene) display relatively low-level resistance. Azithromycin, because of its ability to achieve concentrations at sites of infections, is capable of eradicating mefE-carrying strains. Other resistance mechanisms, involving stimulation of enzymatic degradation, appear not to be clinically significant.
authors.affiliation: Department of Microbiology and Genetics, University Medical Centre, 1 Rue Michel Servet, CH-1211, Geneva, Switzerland. pechere@cmu.unige.ch
authors.forename: J C
authors.initials: JC
authors.lastname: Pechère
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000494:pharmacology*; D001692:Biological Transport; D024881:Drug Resistance, Bacterial; D018432:Drug Resistance, Multiple; D004917:Erythromycin / Q000494:pharmacology; D006095:Gram-Positive Cocci / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D008780:Methyltransferases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D008780:Methyltransferases