Invited Commentary

Charles L. Rice, MD
Arch Surg. 1995;130(11):1241. doi:10.1001/archsurg.1995.01430110099018.
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Efficacy, toxicity, spectrum, drug-drug interactions, pharmacokinetics, bacteriostatic vs bactericidal, pharmacoeconomics, which drug representative brought the doughnuts most recently: these are the criteria that most surgeons have used (not necessarily in this order) for antibiotic selection. Is the potential for the antibiotic to cause excessive release of endotoxin from gram-negative organisms—with the cascade of events that in the most extreme manifestation we call septic shock—now to be added to the selection criteria? The authors of this study have presented intriguing evidence to suggest that it should.

The idea that the killing of bacteria within the host might cause the release of noxious products from the dead bacteria is not new. As Mock et al point out, it was strongly suspected to be a real phenomenon at the turn of the century, and has had cycles of interest since then. As the mechanism of action of antibiotics has become better understood, the


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