R. Leclercq Clinical Microbiology and Infection

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Safeguarding future antimicrobial options: strategies to minimize resistance R. Leclercq Clinical Microbiology and Infection Volume 7, Pages 18-23 (January 2001) DOI: 10.1046/j.1469-0691.2001.0070s3018.x Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Fig 1 Increased prescribing of new macrolides is proportional to increased macrolide resistance among S. pneumoniae. New macrolides include agents with longer half-lives, i.e. spiramycin, roxithromycin, clarithromycin and azithromycin; old macrolides include agents with shorter half-lives, i.e. erythromycin, dirithromycin and josamycin. Resistance is defined as erythromycin MIC ≥1 mg/L. (figure adapted from [5]) Clinical Microbiology and Infection 2001 7, 18-23DOI: (10.1046/j.1469-0691.2001.0070s3018.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Fig 2 Emergence of macrolide resistance (grey) in group A streptococci in Finland and its relationship to macrolide consumption (black). Macrolide resistance defined as erythromycin MIC ≥1 mg/L. (figure adapted from [6,7]) Clinical Microbiology and Infection 2001 7, 18-23DOI: (10.1046/j.1469-0691.2001.0070s3018.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Fig 3 Levels of resistance to non-β-lactam antimicrobials according to penicillin susceptibility among isolates of S. pneumoniae from a 1992–93 Western European and USA collaborative surveillance study [15]. Clinical Microbiology and Infection 2001 7, 18-23DOI: (10.1046/j.1469-0691.2001.0070s3018.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions

Fig 4 Induction of erythromycin A resistance in an inducibly resistant strain of S. pneumoniae incubated with subinhibitory concentrations of macrolides or telithromycin and subsequently challenged with 50 mg/L erythromycin A. Ery, erythromycin A; TEL, telithromycin; CC, uninduced control culture. (figure adapted from [20]) Clinical Microbiology and Infection 2001 7, 18-23DOI: (10.1046/j.1469-0691.2001.0070s3018.x) Copyright © 2001 European Society of Clinical Infectious Diseases Terms and Conditions