Is there a resistance-threshold for macrolide consumption? Positive evidence from an ecological analysis of resistance data from Streptococcus pneumoniae, Treponema pallidum and Mycoplasma genitalium

Abstract

AbstractBackgroundIf we were to keep macrolide consumption below a certain threshold, would this reduce the probability of macrolide resistance emerging? No study that we are aware of has addressed this question.MethodsWe assessed at a country level if there was a macrolide consumption threshold for the selection of a prevalence of macrolide resistance of over 5% in Streptococcus pneumoniae, Treponema pallidum and Mycoplasma genitalium.ResultsWe found evidence for a macrolide consumption threshold of 1.3 defined daily doses per 1000 inhabitants per day (DID) for M. genitalium, 1.8 DID for T. pallidum and 2.3 DID for S. pneumoniae.ConclusionsOur results provide further motivation for macrolide stewardship campaigns that strive to reduce macrolide consumption to levels below at least 2 DID.