ERYTHROMYCIN-RESISTANT GROUP A STREPTOCOCCUS THREAT LEVEL CONCERNING

5,400 450 Estimated Estimated infections in deaths in 2017 2017

Group A Streptococcus (GAS) bacteria can cause mild infections such as sore throat and impetigo, and severe invasive disease such as cellulitis, pneumonia, flesh-eating infections, and sepsis.

WHAT YOU NEED TO KNOW INFECTIONS OVER TIME ■■ GAS is the most common bacterial cause of sore ERYTHROMYCIN RESISTANCE throats, often referred to as strep throat. The percent of invasive GAS infections that are resistant to ■■ GAS can also cause severe invasive infections. erythromycin has nearly tripled in 8 years. People who are elderly, have skin breakdown, or have chronic medical conditions (such as diabetes) are at 25% increased risk. 23% ■■ Each year in the United States, GAS causes approximately 1 to 2.6 million cases of strep throat, 20% 12,500 to 20,000 invasive infections, and 1,250 to 1,900 deaths. 16% 15% 14% ■ 15% 14% ■ Increasing resistance to erythromycin and 13% clindamycin complicates treatment of GAS infections. 12% Data represents only invasive infections. 10% 8%

5% 2010 2011 2012 2013 2014 2015 2016 2017 Percent of Resistant Invasive GAS Infections GAS Invasive of Resistant Percent

25% 23% 22%

20%

16% 15% 15% 14% 13%

10%

5% Percent of Resistant Invasive GAS Infections GAS Invasive of Resistant Percent 0% 2015 2016 2017

Erythromycin Clindamycin 25% 23%

20%

16% 15% 14% 15% 14% 13% 12%

10% ERYTHROMYCIN-RESISTANT GROUP A STREPTOCOCCUS 8%

5% RESISTANCE COMPLICATES TREATMENT INFECTIONS2010 2011 OVER 2012 TIME 2013 2014 2015 2016 2017 Percent of Resistant Invasive GAS Infections GAS Invasive of Resistant Percent We have all known ERYTHROMYCIN AND CLINDAMYCIN RESISTANCE someone who has had strep More than one in five invasive GAS infections are caused by throat—imagine if it were erythromycin- and clindamycin-resistant strains, limiting the untreatable. Germs would patient’s treatment options. spread, more people would 25% get sick, and some might 23% develop rheumatic fever, a 22% complication of strep throat that can damage the heart. 20%

Currently, GAS is not resistant to penicillin or amoxicillin, 16% first-line antibiotics for strep throat. However, doctors often 15% 15% 14% use erythromycin and azithromycin (macrolide antibiotics) 13% to treat strep throat, particularly for people who are allergic to penicillin. Additionally, clindamycin, in combination with 10% penicillin, is the recommended treatment for severe, life- threatening GAS infections such as flesh-eating disease and streptococcal toxic shock syndrome. Increasing resistance 5% to erythromycin and other macrolides, and to clindamycin complicates the treatment of both strep throat and severe invasive infections. Vaccines are in development, but it will Infections GAS Invasive of Resistant Percent 0% be some time before one is available for use. 2015 2016 2017

Erythromycin Clindamycin

ONLINE RESOURCES

About Erythromycin-resistant Group A Streptococcus www.cdc.gov/GroupAStrep/Index.html

Bact Facts Interactive: Data from Active Bacterial Core Surveillance wwwn.cdc.gov/BactFacts/Index.html

This fact sheet is part of CDC’s 2019 Antibiotic Resistance Threats Report. The full report, including data sources, is available at www.cdc.gov/DrugResistance/Biggest-Threats.html. CS298822-A