Among community-acquired infections in the developed
world, those caused by Streptococcus pneumoniae are
the most likely to develop resistance progressively to
the major groups of available antibiotics. In general, the
resistance most associated with S. pneumoniae is penicillin
resistance. However, penicillin resistance has previously
included intermediate resistance and thus falsely
elevated the levels of penicillin resistance reported
worldwide. Currently, penicillin resistance in S.
pneumoniae varies from 0% resistance in the Netherlands
to 71.5% in South Korea [27]. Although this is problematic,
penicillin resistance is at least concentrated in
only certain countries, whereas the levels of resistance
to macrolides are both high and widespread throughout
the world. In many countries macrolide resistance is
higher than penicillin resistance and does not appear
to be arresting. One such country is Hungary, where
penicillin resistance is 2% (37% intermediate) but
erythromycin resistance is 41.7% [28], another is Italy
with penicillin resistance at 10.1% but erythromycin
resistance at 42.9% [27].