title: The geographic relationship between the use of antimicrobial drugs and the pattern of resistance for Streptococcus pneumoniae in Italy.
abstract: OBJECTIVE
  A temporal relationship between the increasing use of antibiotics and the increasing levels of antibiotic resistance has been established for Streptococcus pneumoniae. There are also data that support the presence of a geographic correlation between the level of resistance and the pattern of use among different countries and even within the same country. The aim of this study was to evaluate the potential geographic correlation between the use of beta-lactams and erythromycin in different Italian regions and the resistance of these antibiotics to invasive strains of S. pneumoniae during the period 1999-2000.
  
  
  METHODS
  Ecological study.
  
  
  RESULTS
  In Italy the mean level of resistance for penicillin and erythromycin was 11.4% and 28.9%, respectively. The highest level of resistance for both antibiotics was observed in central and southern regions (i.e. Campania, Lazio and the combined regions of Calabria, Puglia and Sicilia). These regions were also those with the highest consumption of antibiotics. A strong correlation was found between the prevalence of resistance to erythromycin and the regional use of macrolides (r=0.93, P=0.001) and beta-lactams (r=0.84, P=0.002). With regard to penicillin resistance, the greatest correlation was observed for oral penicillin (r=0.85, P=0.002).
  
  
  CONCLUSIONS
  Our study provides further evidence of the association between regional level of antibiotic use and prevalence of antibiotic resistance.
authors.affiliation: Health Protection Agency (CDSC), Communicable Disease Surveillance Centre, 61 Colindale Avenue, NW9 5EQ, London, UK. delia.boccia@HPA.org.uk
authors.forename: D
authors.initials: D
authors.lastname: Boccia
authors.forename: S Spila
authors.initials: SS
authors.lastname: Alegiani
authors.forename: A
authors.initials: A
authors.lastname: Pantosti
authors.forename: M L
authors.initials: ML
authors.lastname: Moro
authors.forename: G
authors.initials: G
authors.lastname: Traversa
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D003625:Data Collection; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004917:Erythromycin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D007769:Lactams / Q000494:pharmacology / Q000627:therapeutic use; D016014:Linear Models; D013290:Streptococcal Infections / Q000188:drug therapy; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D007769:Lactams; D004917:Erythromycin