Meta-analysis of bacterial resistance to macrolides

Michael T. Halpern, Jordana K. Schmier, Lia M. Snyder, Carl Asche, Phillip W. Sarocco, Bruce Lavin, Richard Nieman, Lionel A. Mandell

Research output: Contribution to journalReview article

20 Scopus citations

Abstract

Objectives: Understanding changing resistance patterns is important in determining appropriate antibiotic treatments. This meta-analysis systematically evaluated resistance of Streptococcus pneumoniae and Streptococcus pyogenes to macrolide antibiotics among patients with community-acquired respiratory tract infections. Methods: MEDLINE and EMBASE databases were searched and experts were consulted to identify published and unpublished literature reporting macrolide resistance rates. Identified studies were evaluated by two independent reviewers; those meeting a priori specified criteria (resistance by patient condition and strain, resistance thresholds, 1997-2003 isolates) were included. Data from included studies were abstracted by two independent reviewers using a standard review form. Discrepancies in abstracted data were resolved by the study investigator. Results: Random-effects meta-analysis was performed for outcomes present in at least four studies overall and for specified subgroups. We identified 3849 studies and performed detailed review on 407; of these 29, published between 1998-2003, met the inclusion criteria. Mean resistance of S. pneumoniae isolates to azithromycin was 27.2% [95% confidence interval (CI) 24.6-29.7]; mean resistance to erythromycin was statistically equivalent (30.4%; 95% CI 28.1-32.7). Resistance of S. pyogenes to erythromycin (30.0%; CI 18.6-41.5) was similar to that of S. pneumoniae. Too few studies of clarithromycin were included to allow evaluation of resistance. In subgroup analyses, substantial variation in resistance to erythromycin was seen by geographic area. Conclusions: Reported macrolide resistance of S. pneumoniae varies substantially and may be a significant issue in certain regions. Use of meta-analysis to aggregate individual studies enabled determination of robust values for macrolide resistance. This information is useful for clinical and policy decision makers in developing appropriate antibiotic strategies.

Original languageEnglish (US)
Pages (from-to)748-757
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume55
Issue number5
DOIs
StatePublished - May 1 2005

Keywords

  • Antibiotic resistance
  • Respiratory tract infections
  • Streptococci

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Meta-analysis of bacterial resistance to macrolides'. Together they form a unique fingerprint.

  • Cite this

    Halpern, M. T., Schmier, J. K., Snyder, L. M., Asche, C., Sarocco, P. W., Lavin, B., Nieman, R., & Mandell, L. A. (2005). Meta-analysis of bacterial resistance to macrolides. Journal of Antimicrobial Chemotherapy, 55(5), 748-757. https://doi.org/10.1093/jac/dki060