Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe

Nienke Bruinsma*, Karl G. Kristinsson, Stef Bronzwaer, Paul Schrijnemakers, John Degener, Edine Tiemersma, Waleria Hryniewicz, Jos Monen, Hajo Grundmann, H. Mittermayer, W. Koller, H. Goossens, E. Hendrickx, B. Markova, S. Kalenic, A. Tambic-Andrasevic, P. Urbaskova, D. Monnet, P. Naaber, O. LyytikäinenA. Nissinen, H. Aubry-Damon, P. Courvalin, U. Buchholz, W. Witte, N. Legakis, G. Vatopoulos, M. Füzi, D. O'Flanagan, O. Murphy, R. Raz, H. Edelstein, G. Cornaglia, P. D'Ancona, R. Hemmer, M. Borg, A. de Neeling, A. Hoiby, E. Bjørløw, M. Caniça, I. Codita, M. Gubina, J. Kolman, L. Langsadl, F. Baquero, J. Campos, B. Liljequist, Alan Johnson, M. Wale

*Corresponding author for this work

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61 Citations (Scopus)


Objectives: To forecast trends in resistance to penicillin and erythromycin among Streptococcus pneumoniae in Europe. Methods: Since 1999, the European Antimicrobial Resistance Surveillance System (EARSS) has collected routine antimicrobial susceptibility test results of S. pneumoniae. To observe and predict changes of reduced susceptibility over time, we used a multinomial logistic regression model. Results: Large variations in penicillin and erythromycin non-susceptibility were observed between countries, and reduced susceptibility to erythromycin (17%) has become more frequent than reduced susceptibility to penicillin (10%) in Europe overall. An overall decrease in single penicillin non-susceptibility, but an increase in dual non-susceptibility was observed, indicating a shift of single penicillin to combined non-susceptibility with erythromycin. By 2006, the proportion of single erythromycin and dual non-susceptibility could increase to as much as 20.4% and 8.9%, respectively. Conclusions: Our results indicate that appropriately dosed β-lactams for empirical therapy are still the treatment of choice, and that macrolides should be used with prudence.

Original languageEnglish
Pages (from-to)1045-1050
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Issue number6
Publication statusPublished - Dec 2004

Bibliographical note

Funding Information:
We gratefully thank all national representatives, data managers and the EARSS advisory board for contributing to the success of the network during the past 5 years. We are indebted to all EARSS participants for allowing us to use their data for the present study. The EARSS national representatives for 2002 were H. Mittermayer, W. Koller (Austria), H. Goossens, E. Hendrickx (Belgium), B. Markova (Bulgaria), S. Kalenic, A. Tambic-Andrasevic (Croatia), P. Urbaskova (Czech Republic), D. Monnet (Denmark), P. Naaber (Estonia), O. Lyytikäinen, A. Nissinen (Finland), H. Aubry-Damon, P. Courvalin (France), U. Buchholz, W. Witte (Germany), N. Legakis, G. Vatopoulos (Greece), M. Füzi (Hungary), K. Kristinsson (Iceland), D. O’Flanagan, O. Murphy (Ireland), R. Raz, H. Edelstein (Israel), G. Cornaglia, P. D’Ancona (Italy), R. Hemmer (Luxembourg), M. Borg (Malta), A. de Neeling, E. Tiemersma (The Netherlands), A. Hoiby, E. Bjørløw (Norway), W. Hryniewicz (Poland), M. Canic¸a (Portugal), I. Codita (Romania), M. Gubina, J. Kolman (Slovenia), L. Langsadl (Slovakia), F. Baquero, J. Campos (Spain), B. Liljequist (Sweden), A. Johnson, M. Wale (UK). We thank John Stelling for designing and maintaining the WHONET data-entering program, which is used by many EARSS participants. We thank Dr Nico Nagelkerke for his statistical advice. The EARSS is funded by the European Commission under SI2.324194 (2001CVG4-011) and the Dutch Ministry of Health, Welfare and Sports. This work was performed at the National Institute for Public Health and the Environment, Bilthoven, The Netherlands.


  • Antimacrobial use
  • Antimicrobial resistance
  • Public health


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