In Streptococcus pyogenes, efflux-mediated erythromycin resistance is associated with the mef gene, represented mostly by mef(A), although a small portion of strains carry different mef subclasses. We characterized the composite genetic elements, including mef subclasses other than mef(A), associated with other resistance genes in S. pyogenes isolates. Determination of the genetic elements was performed by PCR mapping. The strains carrying mosaic mef(A/E), in which the 5 region was identical to mef(A) and the 3 region was identical to mef(E), also carried tet(O). The two genes were found enclosed in an element similar to S. pyogenes prophage ⌽m46.1, designated the ⌽m46.1-like element. In S. pyogenes strains carrying mef(E) and tet(M), mef(E) was included in a typical mega element, and in some strains, it was physically associated with tet(M) in the composite element Tn2009. S. pyogenes strains carrying mef(I) also carried catQ; the two genes were linked in a fragment representing a portion of the 5216IQ complex of Streptococcus pneumoniae, designated the defective IQ element. In the only isolate carrying a novel mef gene, this was associated with catQ and tet(M) in a genetic element similar to the 5216IQ complex of S. pneumoniae (5216IQ-like complex), suggesting that the novel mef is in fact a variant of mef(I). This study demonstrates that the composite elements containing mef are shared between S. pyogenes and S. pneumoniae and suggests that it is important to distinguish the mef subclass on the basis of the genetic element containing it.Efflux-mediated macrolide resistance in Streptococcus pyogenes and Streptococcus pneumoniae is conferred by mef and the adjacent msr(D) gene, which code for a two-component transport system (1). The resistance phenotype acquired by the microorganisms is defined as M, since the efflux mechanism confers resistance to macrolides only, as opposed to the MLS B phenotype (resistance to macrolides, lincosamides, and streptogramin B) conferred by the Erm methylase (16).Several allelic variants or subclasses of the mef gene have been described for S. pyogenes and S. pneumoniae, including the more common mef(A) and mef(E) and the rarely encountered mef(I) and mef(O) (3,15,17,20).Although the mef subclasses show a high level of identity at the nucleotide level (from 88% to 94%), each is found embedded in a different genetic element, suggesting a different evolutionary and transmission route (23). In S. pyogenes the most common mef subclass is mef(A) (5, 14), which is carried by two similar genetic elements: Tn1207.3, of approximately 52 kb, and ⌽10394.4, a prophage of approximately 59 kb (2, 21). In S. pneumoniae, mef(A) is carried by Tn1207.1, a defective element of 7.2 kb corresponding to the leftmost mef-containing region of Tn1207.3 (21). In S. pyogenes, a sequence similar to that of Tn1207.1 including mef(A) was found associated with tet(O) in ⌽m46.1, a prophage element of 55.1 kb, also present as a free circular form in the bacterial culture (4).The mef(E) subclass is common in S. ...