Dr Deresinski raises an interesting apparently well-known, practical point. Everything is relative in regard to this knowledge, however. Virtually every infectious disease specialist I have consulted is well aware that aminoglycoside antibiotic agents are inhibited by acid. Not one gastroenterologist or hepatologist (including myself) who I asked was aware of the anti-antibiotic effects of a low pH. Indeed, the inhibitory action of acid has been known since Waksman and Schatz1 described streptomycin, the first clinically useful aminoglycoside antibiotic.
Everything is relative in regard to the inhibition of aminoglycosides by acid, too. Several investigators have shown that this property is characteristic of the whole spectrum of aminoglycoside antibiotics, and that the degree of inhibition varies from agent to agent, from pH to pH, and from organism to organism.2-4
Everything is relative in regard to the efficacy of lactulose and antibiotics in combination. Actually, it is difficult to determine the