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“Background Streptococcus pneumoniae is a major etiological agent of pneumonia, otitis media, sinusitis, and other respiratory pathology. Macrolides remain a primary antibiotic choice for physicians treating such infections due to their broad spectrum of activity, patient tolerance, easy outpatient treatment, high achievable tissue concentrations, and anti-inflammatory properties. Use of macrolides has led to increased rates of resistance in S. pneumoniae [1, 2] and even clinical treatment failure in several cases [3–5]. Macrolide resistance rates in clinical isolates of S. pneumoniae vary greatly among countries [6–9]. The main mechanisms of macrolide resistance in S. pneumoniae also vary geographically.