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The second drugs of choice for treatment of pharyngitis caused by Streptococcus pyogenes (S.pyogenes; group A streptococcus – GAS) are macrolides. In the last few years in Serbia the resistance of GAS to erythromycin was moderately high. Aim: The aim of this study was to determine if there was a change in 2016 2017 in incidence and phenotypes of macrolide resistance in pharyngeal GAS isolates compared to previous years. Material and methods: The study included 107 isolates of GAS obtained from throat swabs of children with pharyngitis under the age of 18 during a two and a half month period in 2016–2017 in Belgrade. Resistance of GAS isolates to antibiotics was examined using disk diffusion method, macrolide resistance phenotypes by D test, and the minimal inhibitory concentrations (MICs) of erythromycin and clindamycin was determined by E test. The results of this study were compared with results obtained from previous studies. Results: Resistance to erythromycin was observed in 6.5% isolates, which represents a fall in comparison with the period between 2008 and 2009. There was a change in the dominant macrolide resistant phenotype M phenotype was dominant in the above mentioned period, while cMLSb (71.4%) dominates in the present period. Resistance to trimethoprim + sulfamethoxazole (98.1%), clindamycin (4.7%) and tetracycline (2.8%) was noticed as well. Conclusion: S.pyogenes resistance to macrolides in Serbia is above regional average, even though there has been a fall in the resistance rate, as well as the change in macrolide resistance phenotype frequency compared to the 2008 – 2009 period. All this indicates the necessity of continuous monitoring of resistance and GAS resistance phenotype to macrolides.

Changes in macrolide resistance phenotype in pharyngeal group a streptococci isolates in children