Letters
Infectious diseases Pharmacology
Volume 186 - Issue 3

An unusual cause of severe metabolic acidosis

Authors:  John V Peter, Natasha Rogers and Sandra L Peake

Med J Aust 2007; 186 (3): 158-159. || doi: 10.5694/j.1326-5377.2007.tb00847.x
Published online: 5 February 2007
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In reply: Boyd and Hedger have raised concerns regarding the initiation and choice of antibiotics in our recent case report.1 Several aspects of this correspondence need to be addressed. The primary focus of the article was to highlight an important and probably underrecognised cause of unexplained metabolic acidosis, and discussion regarding antibiotic choice was not within the scope of the article.

Further, the patient’s management before admission to the intensive care unit was by a different treating team. Subsequent case-note review did not reveal reasons for initiation or choice of antibiotics other than described in our article, although it was evident that gentamicin doses were adjusted based on drug levels. We agree that a less nephrotoxic agent could have been chosen and that the profligate use of antibiotics in the absence of strong evidence of infection could have been avoided.

The excessive use of antibiotics in the current medical milieu may stem from a physician’s lack of confidence, or even legal ramifications of “watching and waiting” in the setting of “fevers, chills, rigors, raised inflammatory markers and neutrophilia”, as encountered in our patient.

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