title: Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe.
abstract: OBJECTIVE
  To forecast trends in resistance to penicillin and erythromycin among Streptococcus pneumoniae in Europe.
  
  
  METHODS
  Since 1999, the European Antimicrobial Resistance Surveillance System (EARSS) has collected routine antimicrobial susceptibility test results of S. pneumoniae. To observe and predict changes of reduced susceptibility over time, we used a multinomial logistic regression model.
  
  
  RESULTS
  Large variations in penicillin and erythromycin non-susceptibility were observed between countries, and reduced susceptibility to erythromycin (17%) has become more frequent than reduced susceptibility to penicillin (10%) in Europe overall. An overall decrease in single penicillin non-susceptibility, but an increase in dual non-susceptibility was observed, indicating a shift of single penicillin to combined non-susceptibility with erythromycin. By 2006, the proportion of single erythromycin and dual non-susceptibility could increase to as much as 20.4% and 8.9%, respectively.
  
  
  CONCLUSIONS
  Our results indicate that appropriately dosed beta-lactams for empirical therapy are still the treatment of choice, and that macrolides should be used with prudence.
authors.affiliation: Centre for Infectious Disease Epidemiology, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands. nienke.bruinsma@rivm.nl
authors.forename: Nienke
authors.initials: N
authors.lastname: Bruinsma
authors.forename: Karl G
authors.initials: KG
authors.lastname: Kristinsson
authors.forename: Stef
authors.initials: S
authors.lastname: Bronzwaer
authors.forename: Paul
authors.initials: P
authors.lastname: Schrijnemakers
authors.forename: John
authors.initials: J
authors.lastname: Degener
authors.forename: Edine
authors.initials: E
authors.lastname: Tiemersma
authors.forename: Waleria
authors.initials: W
authors.lastname: Hryniewicz
authors.forename: Jos
authors.initials: J
authors.lastname: Monen
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004917:Erythromycin