Metformin promotes the inhibitory effect of 5-Aminosalicylic Acid on inflammation-mediated proliferation and progression of colorectal Cancer cell lines

Abstract

August 2015 e49 lead to nephrotoxicity and ototoxicity. However, in SDD, tobramycin suspension is given orally and aminoglycosides are not absorbed via the gut. Therefore, SDD will, generally, not lead to systemic exposure. However, we describe a patient with Graft Versus Host Disease (GVHD) who developed toxic tobramycin levels. Methods: In this case report, we describe a 34 year old male patient with Acute Myeloid Leukemia. After allogenic stem cell transplantation he developed GVHD of the intestines, amongst all leading to severe diarrhea. Previously, several ICU patients with SDD and GVHD developed systemic tobramycin exposure. Therefore, tobramycin levels were measured by means of EMIT Immunoassay (Architect, Abbott). Results: After use of 8 times a day 80 mg tobramycin orally for 30 days, his tobramycin trough level was 3.5 mg/L (reference 20% last 4 days). Tobramycin was stopped and levels dropped to 0.87 mg/L after 2 days and 0.22 mg/L after 4 days. Tobramycin was started again in a regimen of 4 times a day 80 mg tobramycin orally, under daily monitoring of tobramycin levels. Creatinine and urea recovered. High tobramycin levels were contributed to systemic leakage of tobramycin via the intestines. Conclusion: In SDD, tobramycin is normally not absorbed. However, in severe intestine GVHD, systemic absorption of tobramycin can occur. In this patient toxic tobramycin levels were combined with impaired renal function. In patients with GVHD of the intestines and frequent administration of tobramycin-containing SDD frequent monitoring of tobramycin levels is recommended.