Investigation of risk factors for tonsillopharyngitis with macrolide resistant Streptococcus pyogenes in Turkish children

Pediatr Int. 2002 Dec;44(6):647-51. doi: 10.1046/j.1442-200x.2002.01627.x.


Background: Streptococcus pyogenes is the most important causative agent of tonsillopharyngitis. Although penicillin is the drug of choice in streptococcal tonsillopharyngitis, macrolides are recommended drugs in patients who have an allergy to penicillin. However, resistance to macrolides is an important problem in some regions of the world. Risk factors for resistance development have not been investigated sufficiently.

Objectives: To investigate the risk factors for the development of tonsillopharyngitis with macrolide resistant S. pyogenes.

Methods: Three hundred and forty-five children with tonsillopharyngitis caused by S. pyogenes were investigated for various risk factors. Streptococcus pyogenes isolated from children's throat culture were examined for erythromycin, clarithromycin and azithromycin susceptibility.

Results: Two hundred and sixty-three children were found eligible for the analysis of risk factors. Resistances to erythromycin, clarithromycin and azithromycin were detected as 3.8, 4.2 and 4.2%, respectively. Macrolide use of the family members in the last 3 months (odds ratio = 7.04, P = 0.005) has been determined to be a risk factor for the development of tonsillopharyngitis with macrolide resistant S. pyogenes.

Conclusion: Restriction of macrolide antibiotic use appears to be the most important measure to prevent the development of tonsillopharyngitis with resistant S. pyogenes.

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Infant
  • Macrolides
  • Male
  • Microbial Sensitivity Tests
  • Pharyngitis / drug therapy
  • Pharyngitis / microbiology*
  • Retrospective Studies
  • Risk Factors
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / drug effects*
  • Surveys and Questionnaires
  • Tonsillitis / drug therapy
  • Tonsillitis / microbiology*
  • Turkey


  • Anti-Bacterial Agents
  • Macrolides