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Blindness Induced by Double-blindedness-Reply

Blindness Induced by Double-blindedness-Reply Abstract Dr Deresinski raises an interesting apparently well-known, practical point. Everything is relative in regard to this knowledge, however. Virtually every infectious disease specialist I have consulted is well aware that aminoglycoside antibiotic agents are inhibited by acid. Not one gastroenterologist or hepatologist (including myself) who I asked was aware of the anti-antibiotic effects of a low pH. Indeed, the inhibitory action of acid has been known since Waksman and Schatz1 described streptomycin, the first clinically useful aminoglycoside antibiotic. Everything is relative in regard to the inhibition of aminoglycosides by acid, too. Several investigators have shown that this property is characteristic of the whole spectrum of aminoglycoside antibiotics, and that the degree of inhibition varies from agent to agent, from pH to pH, and from organism to organism.2-4 Everything is relative in regard to the efficacy of lactulose and antibiotics in combination. Actually, it is difficult to determine the References 1. Waksman SA, Schatz A: Streptomycin: Origin, nature, and properties. J Am Pharm Assoc 1945;34:273-291.Crossref 2. Abraham EP, Duthie ES: Effect of pH of the medium on activity of streptomycin and penicillin. Lancet 1946;1:455-459.Crossref 3. Young LS, Hewitt WL: Activity of five aminoglycoside antibiotics in vitro against gram-negative bacilli and Staphylococcus aureus. Antimicrob Agents Chemother 1973;4:617-625.Crossref 4. Minuth JN, Musher DM, Thorsteinsson SB: Inhibition of the antibacterial activity of gentamicin by urine. J Infect Dis 1976;133:14-21.Crossref 5. Elkington SG, Floch MH, Conn HO: Lactulose in the treatment of chronic portal systemic encephalopathy: A double-blind clinical trial. N Engl J Med 1969;281:408-412.Crossref 6. Fessel JM, Conn HO: Lactulose in the treatment of acute hepatic encephalopathy. Am J Med Sci 1973;266:103-110.Crossref 7. Atterbury CE, Maddrey WC, Conn HO, et al: Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy: A controlled, double-blind, clinical trial. Am J Dig Dis 1978;23:398-406.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Blindness Induced by Double-blindedness-Reply

Archives of Internal Medicine , Volume 142 (7) – Jul 1, 1982

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340200176038
Publisher site
See Article on Publisher Site

Abstract

Abstract Dr Deresinski raises an interesting apparently well-known, practical point. Everything is relative in regard to this knowledge, however. Virtually every infectious disease specialist I have consulted is well aware that aminoglycoside antibiotic agents are inhibited by acid. Not one gastroenterologist or hepatologist (including myself) who I asked was aware of the anti-antibiotic effects of a low pH. Indeed, the inhibitory action of acid has been known since Waksman and Schatz1 described streptomycin, the first clinically useful aminoglycoside antibiotic. Everything is relative in regard to the inhibition of aminoglycosides by acid, too. Several investigators have shown that this property is characteristic of the whole spectrum of aminoglycoside antibiotics, and that the degree of inhibition varies from agent to agent, from pH to pH, and from organism to organism.2-4 Everything is relative in regard to the efficacy of lactulose and antibiotics in combination. Actually, it is difficult to determine the References 1. Waksman SA, Schatz A: Streptomycin: Origin, nature, and properties. J Am Pharm Assoc 1945;34:273-291.Crossref 2. Abraham EP, Duthie ES: Effect of pH of the medium on activity of streptomycin and penicillin. Lancet 1946;1:455-459.Crossref 3. Young LS, Hewitt WL: Activity of five aminoglycoside antibiotics in vitro against gram-negative bacilli and Staphylococcus aureus. Antimicrob Agents Chemother 1973;4:617-625.Crossref 4. Minuth JN, Musher DM, Thorsteinsson SB: Inhibition of the antibacterial activity of gentamicin by urine. J Infect Dis 1976;133:14-21.Crossref 5. Elkington SG, Floch MH, Conn HO: Lactulose in the treatment of chronic portal systemic encephalopathy: A double-blind clinical trial. N Engl J Med 1969;281:408-412.Crossref 6. Fessel JM, Conn HO: Lactulose in the treatment of acute hepatic encephalopathy. Am J Med Sci 1973;266:103-110.Crossref 7. Atterbury CE, Maddrey WC, Conn HO, et al: Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy: A controlled, double-blind, clinical trial. Am J Dig Dis 1978;23:398-406.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1982

References