The Correspondence by Bryan White and Emily Siegrist1 about clindamycin-resistant group A streptococcal infection attracted much attention in the USA. White and Siegrist argued that although the findings from some studies suggest a decrease in mortality from group A streptococcal infections in the USA, serious infections caused by clindamycin non-susceptible invasive group A streptococcus are increasing due to expansion of several emm types.2 Therefore, we hope to provide some information about clindamycin-resistant group A streptococcus in China to compare its prevalence in different areas.
First, unlike in the USA and other countries and regions, the resurgence of group A streptococcal infection in China is mainly manifested in non-invasive group A streptococcal infections. Rheumatic fever rarely occurs. Next, in China, the resistance rate of group A streptococcus against clindamycin and macrolides in both adults and children has been very high since the 1990s but has varied by geographical location and time period (appendix). Chinese isolates mainly harbour the ermB resistance gene, with the constitutive macrolide, lincosamide, and streptogramin B (cMLSB) resistance phenotypes. In China, clindamycin was not thought to be an appropriate medical intervention.
Finally, the high rate of resistance to clindamycin cannot be attributed to its clinical use because clindamycin was rarely used in paediatric patients in Western Pacific countries (including China).3 Previous studies also suggested cross-resistance between clindamycin and erythromycin.4 Cross-resistance to cMLSB antibiotics is mainly mediated by the erm genes, and various mechanisms are involved in streptogramin B resistance.5
In view of the existing data, there is high resistance to clindamycin and macrolides such as erythromycin; therefore, these treatments should not be recommended as an adjuvant treatment for children with β-lactam antibiotic allergy and group A streptococcal infection in China.
We declare no competing interests. This research was funded by the Shenzhen Key Medical Discipline Construction Fund (SZXK032), the Guangdong Medical Research Fund (A2021437), the Hospital Level Project of Shenzhen Children's Hospital (ynkt2020-zz19), and the Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (SZGSP012). DY and YL contributed equally.
Supplementary Material
References
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