Then, in 1977, Appelbaum and colleagues began seeing penicillin-resistant strains of S. pneumoniae in South Africa, Spain and Hungary.
Pockets of resistance can vary greatly even within a relatively small area.
Multi-drug resistance is another cause for concern. Some strains of S. pneumoniae seen in France are resistant to, not only penicillin, but also erythromycin or co-trimoxazole. This trend is being mirrored in the UK, according to Goldsmith and colleagues. In Northern Ireland, for example, there has been a 13-fold increase in resistance among pneumococci since 1998. This trend is now being seen in other parts of the UK, notably Bristol, Newcastle, Nottingham and Liverpool.