If we were to keep macrolide consumption below a certain threshold, would this reduce the probability of macrolide resistance emerging? No study that we are aware of has addressed this question. We, therefore, assessed at a country level if there was a macrolide consumption threshold for the selection of a prevalence of macrolide resistance of over 5% in Streptococcus pneumoniae, Treponema pallidum, and Mycoplasma genitalium. In this ecological-level analysis, we found evidence for a macrolide consumption threshold of 1.3 defined daily doses per 1,000 inhabitants per day (DID) for M. genitalium, 1.8 DID for T. pallidum, and 2.3 DID for S. pneumoniae. Our results provide further motivation for macrolide stewardship campaigns that strive to reduce macrolide consumption to levels below at least 2 DID.

中文翻译：

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大环内酯消费有阻力阈值吗？来自肺炎链球菌、梅毒螺旋体和生殖支原体耐药数据生态分析的积极证据

如果我们将大环内酯的消耗量保持在某个阈值以下，这会降低出现大环内酯耐药性的可能性吗？我们所知道的任何研究都没有解决这个问题。因此，我们在国家层面评估了是否存在用于选择肺炎链球菌、梅毒螺旋体和生殖支原体中大环内酯耐药率超过 5% 的大环内酯消费阈值。在这个生态层面的分析中，我们发现了大环内酯消费阈值的证据，即生殖器支原体每 1,000 名居民每天摄入量 (DID) 为 1.3 ，梅毒螺旋体为 1.8 DID，肺炎链球菌为 2.3 DID. 我们的结果为大环内酯管理活动提供了进一步的动力，努力将大环内酯的消耗量减少到至少低于 2 DID 的水平。