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Absorption of oral aminoglycosides following bone marrow transplantation
Abstract:
Four patients with severe gastrointestinal reactions receiving oral "nonabsorbable" antibiotics for gut sterilization following bone marrow transplantation absorbed clinically significant amounts of aminoglycoside (gentamicin and/or tobramycin). Serum concentrations of 2.2, 2.6, 5.8, and 12.0 micrograms/ml were measured. Two of these patients had acute graft versus host reactions and two had severe mucositis following cytoreduction with intensive chemotherapy and irradiation. Nephrotoxicity occurred in the latter patients. One patient was studied in detail. Her hospital course and investigative results are presented. Four additional patients with mild gastrointestinal reactions following cytoreduction did not absorb gentamicin when their toxicity was maximal. Serum aminoglycoside determinations are necessary in patients receiving oral aminoglycosides for gut sterilization following bone marrow transplantation if moderate to severe gastrointestinal reactions occur.
Insights
Patients receiving oral antibiotics for gut sterilization after bone marrow transplant can absorb significant aminoglycoside amounts, especially with severe gastrointestinal reactions. Monitoring serum concentrations is crucial for these high-risk patients.
Area of Science:
- Pharmacology
- Transplantation Medicine
- Gastroenterology
Background:
- Bone marrow transplantation (BMT) often involves gut sterilization with oral "nonabsorbable" antibiotics.
- Aminoglycosides like gentamicin and tobramycin are commonly used for this purpose.
- Severe gastrointestinal (GI) reactions can complicate BMT recovery.
Observation:
- Four patients with severe GI reactions following BMT absorbed clinically significant serum concentrations of oral aminoglycosides.
- Measured serum concentrations ranged from 2.2 to 12.0 micrograms/ml.
- Two patients experienced nephrotoxicity, correlating with high serum aminoglycoside levels.
Findings:
- Severe GI reactions in BMT patients receiving oral aminoglycosides can lead to significant drug absorption.
- Patients with mild GI reactions did not show significant gentamicin absorption.
- Nephrotoxicity was observed in patients with documented aminoglycoside absorption.
Implications:
- Serum aminoglycoside monitoring is essential for BMT patients with moderate to severe GI reactions.
- This monitoring can help prevent potentially toxic drug accumulation.
- Clinical practice should adapt to account for potential aminoglycoside absorption in this vulnerable population.