Over the last 15 years, a general increase in macrolide resistance in Streptococcus pyogenes has been observed in many parts of the world (1). In Europe, its prevalence is higher in Mediterranean countries and lower in Scandinavia. In particular, whereas an overall incidence around 43%, the highest rate recorded after a Japanese epidemic in the 1970s (10), was reported in a nationwide survey in Italy (17), the resistance rate remains low (<5%) in Norway (8). An association between erythromycin resistance and cell invasiveness in S. pyogenes has been documented in Italy (3).
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Palmieri et al. (2006) studied this question.
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