The M phenotype is by far the most common mechanism of @entity2929 resistance among @entity4195 isolates in Spain. A geographic analysis of the relationship between within-country differences in the prevalence of M-type resistance to @entity2929 in @entity4195 and the level of consumption of 14- and 15-membered @entity7187 within different provinces was carried out. From 1998 to 1999, a nationwide multicenter surveillance study yielded 2,039 consecutive pharyngeal isolates of @entity4195 . Data on antibiotic consumption for the same period were gathered from IMS Health, and the corresponding daily defined doses per 1,000 inhabitants per day were calculated according to the Anatomic Therapeutic Classification index. @entity7646 use was subdivided into dosages given three @entity227 ( @entity227 ), twice a day (BID), or @entity227 ( @entity227 ). Spearman nonparametric correlation coefficients (R) were calculated, and variables proving to be significantly associated (P < 0.1) were introduced into a linear regression model. The total consumption of @entity7187 presented a significant correlation with the prevalence of resistance (R = 0.527; P = 0.032). Neither @entity227 nor BID macrolide consumption showed significant correlations. Only @entity227 consumption had a significance below 0.1. These data are consistent with the hypothesis that only the total consumption of @entity7187 influences the local rates of M-type @entity2929 resistance in @entity4195 , and subgroups of @entity7187 seem to have an additive rather than a selective effect by contributing to increasing the final amount of @entity7187 used. Local variations in total consumption were associated only with BID consumption (R = 0.849; P = 0.004). The simple linear regression with total macrolide consumption showed a considerable determination coefficient (R(2) = 0.678; P = 0.006). The model explains up to 68% of the measured variation and is clearly better as a predictor of the prevalence of resistance than the mere mean is. By solving the regression equation, the resultant value of 2.2 defined doses per 1,000 inhabitants per day fits with the existence of a critical threshold of selective pressure.

Pharmacoepidemiological analysis of provincial differences between consumption of XXXX and rates of @entity2929 resistance among @entity4195 isolates in Spain.

@entity227 :: ('MESH:D014786', 'Disease') :: ['TID', 'OD', 'once a day', 'times a day'] @entity7646 :: ('CHEBI:25106', 'Chemical') :: ['Macrolide'] @entity2929 :: ('MESH:D004917', 'Chemical') :: ['erythromycin'] @entity4195 :: ('1314', 'Species') :: ['Streptococcus pyogenes', 'S. pyogenes'] @entity7187 :: ('MESH:D018942', 'Chemical') :: ['macrolides']
@entity7187 :: (MESH:D018942,Chemical) :: ['macrolides']
