title: Antibiotic-induced D-lactic acidosis.
abstract: OBJECTIVE
  To describe a case of oral antibiotic-induced D-lactic acidosis in a patient with enteric overgrowth of Lactobacillus acidophilus.
  
  
  METHODS
  Single case study.
  
  
  METHODS
  University-affiliated community hospital.
  
  
  METHODS
  Oral carbohydrate challenge test with 4000 kcal/d.
  
  
  RESULTS
  A patient had several episodes of D-lactic acidosis after receiving oral antibiotics. Stool cultures yielded Lactobacillus acidophilus resistant to the implicated agents. Provocative challenge with dietary carbohydrate alone, in the absence of antibiotics, failed to reproduce the syndrome.
  
  
  CONCLUSIONS
  Oral antibiotics may induce D-lactic acidosis in patients with the short-bowel syndrome by promoting the overgrowth of resistant D-lactate-producing organisms. Interactions between carbohydrate intake and antibiotic use are likely determinants in the development of this syndrome. Periodic use of stool cultures with antimicrobial susceptibility testing may assist in the management of these patients by optimizing the selection of antimicrobial agents.
authors.affiliation: Brown University, Providence, Rhode Island, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Coronado
authors.forename: S M
authors.initials: SM
authors.lastname: Opal
authors.forename: D C
authors.initials: DC
authors.lastname: Yoburn
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004318:Doxycycline / Q000009:adverse effects; D004352:Drug Resistance, Microbial; D006801:Humans; D007779:Lactobacillus acidophilus / Q000187:drug effects / Q000254:growth & development; D008297:Male; D008875:Middle Aged; D012778:Short Bowel Syndrome / Q000150:complications / Q000382:microbiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D004318:Doxycycline