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Abstract: Penicillin remains the drug of choice for the treatment of Group A Streptococci infections. However, for patients hypersensitive to β-lactam antibiotics and in whom therapy with these drugs fails, macrolides are often the recommended substitute. Over the past few years, increased rates of erythromycin resistance have been reported for Group A Streptococci worldwide. The known mechanisms of macrolide resistance in Streptococci are modification of the ribosomal target by a methylase encoded by erm genes and a macrolide-specific efflux mechanism encoded by the mef(A) gene. Mutation of the ribosomal target of macrolides is a rare resistance mechanism in streptococci. A total of 22.4% in France in 2003 of A Group Streptococcus were erythromycin resistant, and 69.4%, 4.2%, and 26.4% of these isolates harbored ermB, ermA, and mefA, respectively. Increasing resistance in France is mainly associated with a few emm type 28 clones. [Copyright &y& Elsevier]