Antibiotic resistance in group A streptococci.

Although erythromycin resistance in GABHS has been a major problem in Japan and in Finland, it has not been a problem in the United States. The susceptibility of GABHS to the newer macrolide antibiotics seems to be similar to that of erythromycin. Comprehensive, community-wide programs to continuously monitor for erythromycin resistance in GABHS would be difficult to justify; however, because little is known about how erythromycin resistance in GABHS is acquired or spread, it would be reasonable to periodically monitor isolates of GABHS for erythromycin resistance. Despite more than four decades of use of penicillin in treating GABHS infections, no significant change has occurred in the in vitro susceptibility of GABHS to penicillin. The resurgence of severe, invasive GABHS infections and of acute rheumatic fever is not attributable to the emergence of strains of GABHS with increased resistance to penicillin. A substantial proportion of GABHS are currently resistant to tetracyclines, and these agents are inappropriate for treating GABHS infections. Although little recent information is available about the susceptibility of GABHS to sulfonamides, these agents have been shown to be ineffective in eradicating GABHS form the upper respiratory tract regardless of the in vitro sensitivities. GABHS have not been shown to be resistant to any of the commonly used oral cephalosporins; however, a great deal of variability exists among these agents in their activity against GABHS. Clindamycin resistance in GABHS has remained unusual. This agent is an alternative for treating GABHS infections due to macrolide-resistant strains in patients who cannot be treated with beta-lactam antibiotics.