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Management of Septic Shock

Richard M. Reich, MD
JAMA. 1980;243(20):2029. doi:10.1001/jama.1980.03300460013008.
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To the Editor.—  The article by William Schumer, MD (242:1906, 1979), on the management of septic shock makes several dubious statements and recommendations. The statement, "If... [the septic shock is due to a] pneumonitis, which is caused by Gram-positive bacteria, then a penicillin, a cephalosporin, or an aminoglycoside can be used," is rather ambiguous. The placing of the comma after pneumonitis wrongly implies that all pneumonias are caused by Gram-positive bacteria or, indeed, that all pneumonias are infectious in nature. Moreover, the recommendation that aminoglycosides can be used as single-agent therapy for Grampositive infections cannot be condoned; their high toxic to therapeutic ratio compared with other antimicrobial agents and clinical failure against infections with Streptococcus pneumoniae and S pyogenes (despite in vitro sensitivity) are well known.1 Initial treatment of bacterial pneumonia should be based on examination of a Gram-stained smear of sputum.The dosage of 9 mg/kg/day of gentamicin


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