Do you temporarily pause sodium bicarbonate in patients with CKD and associated metabolic acidosis who are prescribed a short course of antibiotics?

Sodium bicarbonate increases not just systemic pH, but also gastric and urinary pH at the same time. This can lead to increased or decreased absorption or excretion of antibiotics.

Some antibiotics require a low stomach pH to be well absorbed. These include cefuroxime and cefpodoxime, and azole antif...

I don't, unless the serum CO2 is on the high side. There is more literature now showing that even giving iron is safe in the setting of infection. I don't see giving bicarbonate as being a problem at all.

No, I do not temporarily hold sodium bicarbonate in patients with CKD-associated metabolic acidosis who are prescribed a short course of antibiotics. Holding sodium bicarbonate unnecessarily may cause the systemic acid level to rebound. Since sodium bicarbonate can raise gastric pH and significantly...