Comparative in vitro activity of moxifloxacin by E-test against Streptococcus pyogenes

Macrolides are currently used to treat Streptococcus pyogenes infections where allergy or resistance prevents the use of penicillin. However, growing macrolide resistance is now seen worldwide, with rates of 5%-40% being reported. In this context it is therefore important to have other therapeutic options. The aim of this study was to ascertain the potential role of moxifloxacin, a third-generation fluoroquinolone, in the treatment of infections caused by group A S. pyogenes. The antimicrobial susceptibilities of S. pyogenes isolated from 197 adult patients with pharyngotonsillitis were analyzed by the E-test. Twelve percent of the isolates were resistant to macrolides, and 5% showed diminished susceptibility toward penicillin; none of the strains were resistant to cefotaxime or to moxifloxacin (90% minimum inhibitory concentration, 0.25 microg/mL). Therefore, moxifloxacin may be a therapeutic option in the management of S. pyogenes infections when penicillin cannot be used or when macrolide resistance may be a local issue. Clinical studies of moxifloxacin in pharyngotonsillitis are warranted.

[Measles in the young adult. Clinical features of 201 cases]

The clinical and laboratory characteristics of 201 cases of measles and its associations with complications were analyzed during an outbreak of this disease in Mexico City. The complications were hepatitis (45%), bacterial pneumonia (17%), oral candidiasis (13%), upper gastrointestinal tract hemorrhage (13%), epistaxis (8%), encephalitis (4%), subcutaneous emphysema (2%), and hypocalcemic tetany (1%). In a subgroup of 20 consecutive patients hypocalcemia was found in 14 cases (70%), associated with high levels of calcitonin in three cases. An increased lactate dehydrogenase (LDH) was observed in 83% of the patients, showing a significant association with the occurrence of complications (p = 0.04) especially in the patients with values of LDH above 750 IU/mL (odds ratio of 6.4). Two patients died (1% mortality). The young patients with measles can develop serious complications, and an increased level of LDH may be a prognostic indicative of these complications.