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We correlated outpatient antibiotic use with prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP), macrolide-resistant S. pneumoniae (MRSP), and macrolide-resistant S. pyogenes (MRGAS) in 20 countries. Total antibiotic use was correlated with PNSP (r = 0.75; p &lt; 0.001), as was macrolide use with MRSP (r = 0.88; p &lt; 0.001) and MRGAS (r = 0.71; p = 0.004). Streptococcal resistance is directly associated with antibiotic selection pressure on a national level.

Antibiotic Selection Pressure and Resistance inStreptococcus pneumoniaeandStreptococcus pyogenes