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April 22, 1983

Cefotaxime Failure in Group A Streptococcal Meningitis

JAMA. 1983;249(16):2176. doi:10.1001/jama.1983.03330400028008

To the Editor.—  The recent report by Iannini and Kunkel in The Journal (1982;248:1878) warrants critical comment. The authors state that their 80-year-old patient with septic arthritis had "gram-positive cocci in short chains present on a stained smear" of the joint fluid. They then state that "after informed consent, the patient was treated with 2 g of intravenous cefotaxime sodium every six hours." My concern is how well this patient could have been informed if she elected to be treated with a new drug that is at least tenfold less active and at least ten times more expensive than penicillin G sodium against group A streptococci, which should have been presumed as the cause of infection from the Gram stain and confirmed as such within 24 hours. In addition, cefotaxime has a broad range of antimicrobial activity not only unneeded in this patient but also unwanted. Needless suppression of normal