Community
In the community two large studies have shown a possibility of decreasing antibiotic resistance through community-wide interventions (21,22). Both studies were performed in response to a sudden dramatic increase in antibiotic resistance. The first study was conducted in Finland in response to a nationwide increase in erythromycin resistance in Streptococcus pyogenes. National recommendations advocating a decreased use of macrolide antibiotics were launched at the end of 1991 (21). During 1992 the use of macrolides decreased from 2.40 to 1.38 DDD/ TIND and remained at this level during the study period. The increase in erythromycin resistance in S. pyogenes seen in 1992–1993 was followed by a significant decrease in 1994 and 1995. However, closer examination of the data presented in the article reveals that the use of macrolides significantly decreased already in 1989. The reduction in macro- lide resistance was thus seen 5 years after the initial decrease in macrolide sales, indicating that other factors than the decreased use might have contributed to the decrease in resistance seen in 1994–1995. Later it was shown that one clone of S. pyogenes, being resistant to erythromycin only, seemed to be respon- sible for the increase in macrolide resistance (54). Thus, the observed differences might have been natural fluctuations, although probably enhanced both by the macrolide use in the late 1980s and later the decrease in macrolide consumption.