Hold the Erythromycin

Source: Seppala H, et al. N Engl J Med 1997;337:441-446.

Seppala and colleagues report that the use of erythromycin tripled during the 1980s in Finland, which was associated with an increase in macrolide-resistance in group A streptococcus isolates. A nationwide effort was, therefore, launched in 1991 to reduce the use of macrolides in the treatment of respiratory and soft tissue infections, primarily through physician education and treatment guidelines.

Within two years, the frequency of macrolide resistance of group A Streptococcal isolates dropped dramatically. A total of 39,247 group A streptococcal isolates from throat swabs and pus samples were studied. Erythromycin resistance dropped from a peak of 19% in 1992 to 8.6% in 1996.

Despite their success, Seppala et al expressed concern that the increase in macrolide use observed in 1995, driven by physician interest in using newer agents such as azithromycin and roxithromycin, could result in a resurgence in macrolide resistance. Nevertheless, they were able to demonstrate that educational efforts and treatment guidelines can affect physician prescribing practices with a direct—and fairly immediate—impact on antimicrobial resistance patterns, at least in this relatively stable group of people.