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JAC Advance Access published online on July 21, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh375
© 2004 by The British Society for Antimicrobial Chemotherapy
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Received February 19, 2004
Revised April 22, 2004
Accepted June 25, 2004

Original article

Effect of social and climatological factors on antimicrobial use and Streptococcus pneumoniae resistance in different provinces in Spain

César García-Rey 1*, Asunción Fenoll 2, Lorenzo Aguilar 1, Julio Casal 2

1 Medical Department, GlaxoSmithKline, Parque Tecnológico de Madrid, C/Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
2 National Reference Laboratory of S. pneumoniae, Instituto de Salud Carlos III, Spain

* To whom correspondence should be addressed. E-mail: cesar.garcia-rey{at}gsk.com.


  Abstract

Objectives: To investigate the association between geographical differences in antibiotic consumption and resistance of Streptococcus pneumoniae to penicillin and erythromycin in 15 provinces of Spain, taking into account the potential influence of a series of social and climatological factors.

Methods: Possible correlations between prevalence of resistance to penicillin and erythromycin of S. pneumoniae, as determined in the national reference laboratory, and antibiotic consumption, and socio-economic and climatological variables were investigated. Partial correlations and multivariate linear regression were performed to assess the relative importance of variables predicting resistance and to investigate explicative factors for antibiotic consumption, respectively.

Results: A correlation was found between resistance and educational level, the proportion of young people in the population and climate, but was explained by their effects on differences in antibiotic use, which appeared to be the basic and only force behind resistance patterns in different geographical areas. Antibiotic use was found to be determined by the interplay of adult illiteracy, rainfall and GDP per capita.

Conclusions: Interventions aimed at improving educational level and economic growth might therefore be followed by a noticeable reduction in overall antibiotic consumption, which might in turn be followed by a reduction in penicillin and erythromycin resistance in clinical isolates of S. pneumoniae.

Keywords: antibiotic consumption; resistance; S. pneumoniae.
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