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American Journal of Critical Care. 2002;11: 196-197
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LETTERS TO THE EDITORS

To the Editors:

I am a clinical pharmacist at a large teaching hospital in Charlottesville. I enjoyed reading the article "Necrotizing Fasciitis: A Case of Clostridial Myonecrosis" (May 2001:181–187) by Leah M. Kramer and Lynn V. Doering. However, I would like clarification. At one point, the authors state that the patient was getting 2 aminoglycosides, gentamycin and tobramycin, at once. This may explain the rise in Scr, based on the high once-a-day doses of each that the patient was receiving. Also, the authors state that the patient received low-dose heparin for a DVT. I am not familiar with this type of treatment. Could the authors clarify these 2 issues?

Bruce Jones, Rph
Charlottesville, Va

The authors reply

We appreciated your interest regarding our article. You have identified 2 interesting points. First, you attributed the rise in serum creatinine to the administration of 2 aminoglycoside antibiotics, gentamycin and tobramycin. We also identified this as a cause of the rise in serum creatinine in addition to CT contrast and volume depletion, as demonstrated in the postoperative problems section of text. The patient’s antibiotic coverage was then changed to Levaquin in place of the aminoglycosides and penicillin to decrease the nephrotoxic effects. PCN is the drug of choice for clostridial infections; however, antibiotics should cover other anaerobes as well as aerobic organisms. Recommended initial empiric therapy consists of PCN, an aminogly-coside, and a cephalosporin.1,2 In this case; however, given positive cultures for gram-positive rods, the aminoglycosides and PCN were the antibiotics administered by the infectious disease physicians.

Secondly, you asked about low-dose heparin for DVT treatment. Thank you for identifying this error in text. The treatment for the lower extremity DVT was low molecular weight heparin subcutaneous injections and not low-dose heparin.

References

  1. Hirn M. Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. Eur J Surg Suppl. 1993;570:1–36.[Medline]
  2. Gonzalez MH. Necrotizing fasciitis and gangrene of the upper extremity. Hand Clin. 1998;14:635–645.[Medline]




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