ANTIBIOTIC-INDUCED D-LACTIC ACIDOSIS

Objective: To describe a case of oral antibiotic-induced D-lactic acid osis in a patient with enteric overgrowth of Lactobacillus acidophilus . Design: Single case study. Setting: University-affiliated community hospital. Intervention: Oral carbohydrate challenge test with 4000 kca l/d. Main Results: A patient had several episodes of D-lactic acidosis after receiving oral antibiotics. Stool cultures yielded Lactobacillu s acidophilus resistant to the implicated agents. Provocative challeng e with dietary carbohydrate alone, in the absence of antibiotics, fail ed to reproduce the syndrome. Conclusions: Oral antibiotics may induce D-lactic acidosis in patients with the short-bowel syndrome by promot ing the overgrowth of resistant D-lactate-producing organisms. Interac tions between carbohydrate intake and antibiotic use are likely determ inants in the development of this syndrome. Periodic use of stool cult ures with antimicrobial susceptibility testing may assist in the manag ement of these patients by optimizing the selection of antimicrobial a gents.