A total of 238 erythromycin-resistant Streptococcus pyogenes isolates were collected in 1986-1997 from eight different countries in Europe and North and South America. The antibiotic susceptibility patterns of all isolates and the resistance genes of 92 isolates of known clonal origin were studied. The mefA gene was detected in all 54 isolates with the M-phenotype and was found in every country. The ermTR and the ermB genes were detected in 27 and 11, respectively, of the 38 isolates with the macrolide-lincosamide-streptogramin B resistance phenotypes. In addition to the mefA gene, the recently sequenced ermTR gene was also widely distributed among isolates of different clonal origin.