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May 23, 1980

Management of Septic Shock-Reply

JAMA. 1980;243(20):2029. doi:10.1001/jama.1980.03300460013009

In Reply.—  Dr Reich's comments concerning my recommendations for the management of septic shock are duly noted. Regarding the placement of a comma after pneumonitis, this is an editorial error wrongly implying that all pneumonias are caused by Gramnegative bacteria.I did not intend to recommend aminoglycosides as a single-agent therapy and hope that other readers did not infer this type of information.The recommended antibiotic regimen of a primary dosage of 9 mg/kg/day until serum gentamicin levels can be examined is not excessive. Please refer to the study by Zaske and associates' study on increased gentamicin dosage requirements in burn patients with Pseudomonas infections. To treat these virulent Gram-negative bacteria effectively, high dosages of gentamicin were needed to maintain serum levels between 8 γ/mL and 12 γ/mL.The possibility of renal insufficiency developing in septic shock patients because of the high antibiotic dosage is not as critical as the