There are high rates of macrolide-resistant Streptococcus pneumoniae throughout the United States, according to a study published in Open Forum Infectious Diseases. Investigators identified 3,626 patients with a positive S. pneumoniae blood or respiratory culture evaluated between October 2018 and September 2019 at 329 hospitals across nine U.S. Census geographic regions. Macrolide resistance in S. pneumoniae is 39.5% overall. Macrolide resistance was seen in 47.3% of S. pneumoniae obtained from respiratory cultures and in 29.6% from blood cultures. Macrolide resistance in respiratory isolates was at least 25% in all regions of the US. Higher rates of macrolide resistance were seen among ambulatory patients (45.3%) versus inpatients (37.8%). “The high rates of macrolide-resistant S. pneumoniae throughout the United States [are] the latest in mounting evidence for the need to combat the public health risks of antibiotic resistance,” a coauthor said in a statement. “Indiscriminate use of macrolides for viral conditions has been highlighted during COVID-19; the corollary here is clinicians now need to consider alternatives to macrolide monotherapy for suspected community-acquired pneumonia.”