A regionwide intervention to promote appropriate antibiotic use in children reversed trends in erythromycin resistance to Streptococcus pyogenes.

Streptococcus pyogenes is the major bacterial pathogen responsible for acute pharyngitis in children. Oral penicillin is the drug of choice for streptococcal pharyngitis, while macrolides are an alternative option for patients allergic to penicillin. The frequent use of macrolides promotes the spread of erythromycin resistance (1-2), but reducing the use of these antibiotics has been correlated with a decline in resistance to Streptococcus pyogenes, as shown by the Finnish experience (3-4). The present study, performed in Italy between 2007 and 2013, aimed to describe trends in macrolide prescriptions and of erythromycin resistance in Streptococcus pyogenes isolated from children with pharyngitis.