title: Macrolide resistance rates in respiratory pathogens in Slovenia following reduced macrolide use.
abstract: 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.
authors.affiliation: University Medical Centre, Department of Infectious Diseases, Japljeva 2, 1525 Ljubljana, Slovenia. milan.cizman@mf.uni-lj.si
authors.forename: Milan
authors.initials: M
authors.lastname: Cizman
authors.forename: Bojana
authors.initials: B
authors.lastname: Beović
authors.forename: Katja
authors.initials: K
authors.lastname: Seme
authors.forename: Metka
authors.initials: M
authors.lastname: Paragi
authors.forename: Iztok
authors.initials: I
authors.lastname: Strumbelj
authors.forename: Manica
authors.initials: M
authors.lastname: Müller-Premru
authors.forename: Silva
authors.initials: S
authors.lastname: Cad-Pecar
authors.forename: Marko
authors.initials: M
authors.lastname: Pokorn
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006193:Haemophilus influenzae / Q000187:drug effects; D006801:Humans; D018942:Macrolides / Q000494:pharmacology* / Q000627:therapeutic use; D001936:Moraxella catarrhalis / Q000187:drug effects; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D017524:Slovenia / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000187:drug effects; D013297:Streptococcus pyogenes / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides