To the Editor:—
In The Journal, page 236, there is a clinical note by Hoffman and Carvalho entitled "Retrograde Pyelography and Use of Contrast Mediums Containing Neomycin." There can be no quarrel with the authors' observations in two parallel series of 100 patients each with retrograde pyelography with and without the addition of 2.5% neomycin as an antimicrobial additive. In each series two patients with bacteremic episodes were observed. These required supplementary antibiotic therapy.We take issue, however, with the authors' conclusion that "the prophylactic or therapeutic value of the addition of neomycin sulfate to opaque mediums seems insufficient to justify its use at an increased cost." Let us consider the added cost. Agreeing wholeheartedly with the authors that 3 cc. of contrast medium is adequate for visualization of the usual renal pelvis, and allowing for bilateral pyelograms in every case, plus the loading of a syringe with 5 cc.