I have a thing about Gentamicin, I often find I am adding it to a patients’ management when I’m called out of hours. In fact my wife frequently comments that “all on call queries can be solved with a good dollop of Gentamicin!” Hmm...it’s not the only treatment I prescribe; although it has its uses… So why does it get left out of the management of patients who really need it? Often the reason is that the doctor is frightened of it causing renal failure. I find this argument really baffling and I think that in most situations they have got the balance of risk wrong.
Most of us are aware of the possible severe side-effects of the drugs we commonly prescribe to our patients, but just how common are these, and do we have a misperception of how common they are based upon our fear of them occurring? A recent patient brought this home to me, and made me look at an antibiotic I recommend quite frequently in a bit more detail.
The patient was a lady in her 50s who presented to the hospital with severe shortness of breath and a dry cough. She had a maculopapular rash and swollen knees. Her chest x-ray showed patchy bilateral shadowing and she was so short of breath that she required non-invasive ventilation. The team started her on antibiotics for community acquired pneumonia and the next day she was much better. In fact she got better so quickly that the question was raised as to whether this was actually a pneumonia or was there something else going on?
I was called from the Emergency Department about a very unwell patient who was being reviewed by the Critical Care team with a view to taking him to the Intensive Care Unit. The patient was a 64 year old man who had become unwell over the preceding 48 hours, and now was septic with a severe pneumonia.
Further questioning revealed that he smoked about 40 cigarettes a day and drunk over 40 units of alcohol a week. He had not travelled recently and had no occupational risk factors for specific causes of pneumonia (e.g. plumber or heating engineer and Legionella pneumophila). Specifically I asked whether he was coughing up sputum that looked like “red currant jelly”. “It’s odd that you should ask that”, replied the doctor on the phone, “but yes, that’s exactly what he is coughing up”.