Dr Mulla's data from a population-based surveillance of invasive GAS infection in Florida, conducted between 1996 and 2000, appears to corroborate our findings of a high case fatality rate associated with invasive GAS infection presenting as pneumonia. Dr Mulla's comment about fluoroquinolone use in his cohort prompted us to reexamine our data. Unfortunately, in our cohort of patients with GAS pneumonia, only 18 (8%) received initial empiric therapy that included a fluoroquinolone and only 3 (1.4%) received initial monotherapy with a fluoroquinolone.1 For this reason, we cannot comment on outcomes specifically associated with treatment of GAS pneumonia with fluoroquinolones. The rapid progression from diagnosis to death in many of our cases suggests, however, that major differences in outcome between different classes of antibiotics are not likely to occur. As we suggested in our article, "New therapies instituted early in the disease process will be required before improvements in outcome will be seen."1 All patients should receive an antibiotic with proven efficacy against GAS infection.
Muller MP, McGeer A. Group A Streptococcal Pneumonia—Reply. Arch Intern Med. 2003;163(17):2101-2102. doi:10.1001/archinte.163.17.2101-a