Journal of Antimicrobial Chemotherapy (2000) 46, 767-773
© 2000 The British Society for Antimicrobial Chemotherapy
Streptococcus pneumoniae resistance to erythromycin and penicillin in relation to macrolide and ß-lactam consumption in Spain (1979–1997)
a Research Area, Fundación Jiménez Díaz, Madrid; b Medical Department, SmithKline Beecham Pharmaceuticals, C/Valle de la Fuenfría no. 3, D-28034 Madrid; c Microbiology Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid; d Clinical Microbiology Department, Hospital Ramón y Cajal, Madrid, Spain
Streptococcus pneumoniae resistance to penicillin and erythromycin in relation to ß-lactam and macrolide consumption in Spain over 19 years (1979–1997) was studied from resistance data collected by a search of the literature. Antibiotic consumption was expressed in defined daily dosage (DDD)/1000 inhabitants/day. A significant relationship (P < 0.001) between erythromycin resistance (MIC 
1 mg/L) and global macrolide consumption (r = 0.942), as well as between high-level penicillin resistance (MIC 2 mg/L) and global ß-lactam consumption (r = 0.948) was observed. The relationship between erythromycin resistance and macrolide consumption was due mainly to consumption of macrolides taken twice a day (adjusted r2 = 0.886). Prevalence of high-level penicillin resistance correlated with consumption of oral cephalosporins (adjusted r2 = 0.877); however, there appeared to be no correlation of consumption of oral or parenteral aminopenicillins, narrow-spectrum penicillins or cephalosporins with intermediate-level penicillin resistance (MIC 0.12–1 mg/L). The prevalence of high-level penicillin and of erythromycin resistance were also strongly correlated with each other (r = 0.903, P < 0.001). In addition to global consumption, different categories of resistance (high or intermediate), and the differential capability of antibiotics to select resistance, must be taken into account when studying antibiotic impact on bacterial populations. Although this ecological analysis is not able to demonstrate a causal relationship between antibiotic consumption and development of resistance, it suggests that overuse of certain specific antibiotics is more likely to be related to the increase in drug-resistant strains of S. pneumoniae.
* Corresponding author. Tel: +34-91-334-5275; Fax: +34-91-334-5141; E-mail: lorenzo.aguilar-alfaro{at}sb.com
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