Granizo J J, Aguilar L, Casal J, Dal-Ré R, Baquero F
Research Area, Fundación Jiménez Díaz, Madrid, Spain.
J Antimicrob Chemother. 2000 Dec;46(6):959-64. doi: 10.1093/jac/46.6.959.
The relationship between Streptococcus pyogenes resistance to erythromycin and macrolide consumption in Spain was studied. Erythromycin resistance was highly correlated with the consumption of total macrolides (r = 0.88, P<0.01). When macrolides were grouped into posological subgroups according to their pharmacokinetic and pharmacodynamic properties and analysed separately, erythromycin resistance appeared to be related mainly to those macrolides taken twice daily (bd) (r = 0.86, P<0.01) and those taken once daily (od) (r = 0.87, P<0.01), but not to those taken four (qds) or three times a day (tds) (r = -0.04, P: = 0.90). A progressive increase in the erythromycin resistance curve was seen after the consecutive introduction of both bd and od macrolides, which contributed to the increase in the total macrolide consumption, replacing tds macrolide prescription. Although this ecological analysis cannot establish an unequivocal causal relationship between antibiotic consumption and S. pyogenes resistance, the data are consistent with the hypothesis that widespread use of macrolides, mainly of bd and od macrolides, resulted in an increased prevalence of S. pyogenes resistant to erythromycin in Spain.
研究了西班牙化脓性链球菌对红霉素的耐药性与大环内酯类药物使用量之间的关系。红霉素耐药性与总大环内酯类药物的使用量高度相关（r = 0.88，P<0.01）。当根据其药代动力学和药效学特性将大环内酯类药物分组为剂量学亚组并分别进行分析时，红霉素耐药性似乎主要与每日服用两次（bd）和每日服用一次（od）的大环内酯类药物有关（r = 0.86，P<0.01），而与每日服用四次（qds）或每日服用三次（tds）的药物无关（r = -0.04，P = 0.90）。在连续引入bd和od大环内酯类药物后，红霉素耐药曲线呈逐步上升趋势，这导致了总大环内酯类药物使用量的增加，取代了tds大环内酯类药物的处方。尽管这种生态学分析不能确定抗生素使用与化脓性链球菌耐药性之间明确的因果关系，但这些数据与以下假设一致，即在西班牙，大环内酯类药物（主要是bd和od大环内酯类药物）的广泛使用导致了对红霉素耐药的化脓性链球菌患病率增加。
