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Progression of Group A Streptococcal Necrotizing Fasciitis During Moxalactam Therapy-Reply

Harold C. Neu, MD
Arch Intern Med. 1984;144(4):857. doi:10.1001/archinte.1984.00350160226041.
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In Reply.  —The letter concerning the failure of moxalactam therapy in the case of necrotizing fasciitis due to S pyogenes is a worthwhile cautionary note. In my review of the new cephalosporin antibiotics,1I did note the lower activity of moxalactam against S pyogenes (group A) Streptococcus agalactiae (group B), S pneumoniae, and even Staphylococcus aureus. In another article, I discussed in detail the chemical aspects that cause this loss of gram-positive activity in an attempt to achieve gram-negative activity and in particular to achieve some anti-Pseudomonas aeruginosa activity. I would agree that the serum levels of moxalactam after a 2-g dose should be 200 mg/L and thus well above a minimal inhibitory level of 6 mg/L. To be honest, I would suspect that even with penicillin G, which inhibits group A


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