In Belgium, decreasing macrolide, lincosamide, streptogramins B, and tetracycline use during 1997-2007 correlated significantly with decreasing macrolide-resistant Streptococcus pyogenes during 1999-2009. Maintaining drug use below a critical threshold corresponded with low-level macrolide-resistant S. pyogenes and an increased number of erm(A)-harboring emm77 S. pyogenes with low fitness costs.
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Van Heirstraeten, L., Coenen, S., Lammens, C., Hens, N., Goossens, H., & Malhotra-Kumar, S. (2012). Antimicrobial drug use and macrolide-resistant Streptococcus pyogenes, Belgium. Emerging Infectious Diseases, 18(9), 1515–1518. https://doi.org/10.3201/eid1809.120049