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Progression of Group A Streptococcal Necrotizing Fasciitis During Moxalactam Therapy

David N. Gilbert, MD; Glenn R. Thorp, MD
Arch Intern Med. 1984;144(4):856-857. doi:10.1001/archinte.1984.00350160226040.
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To the Editor.  —Third-generation cephalosporins have an expanded spectrum of activity against aerobic gram-negative bacilli. The decreased activity of these compounds against aerobic gram-positive cocci has received less emphasis.1 The following case illustrates the rapid progression of group A streptococcal infection during moxalactam therapy.

Report of a Case.  —A pruritic infection in the inguinal area, which was clinically consistent with tinea cruris, developed in a 67-year-old man. Despite pruritus, no treatment was instituted. Ten days later, there was the dramatic onset of chills and fever with pain, erythema and induration in the skin parallel to the inguinal ligament and over the right greater trochanter. The patient was admitted to the hospital, blood cultures were obtained, and empiric therapy with moxalactam disodium was begun in a dosage of 2 g intravenously every eight hours. Sixteen hours later, the involved area had roughly doubled in size, and the moxalactam therapy was


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