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The aim of this paper was to observe the clinical effect of gentamycin combined with sodium bicarbonate for the prevention of irinotecan-induced diarrhea. A total of 98 patients with stage Ⅳ cancers were recruited and divided into a prevention group (52 patients) and a control group (46 patients). All patients received the chemotherapy including irinotecan. The prevention group received gentamycin and sodium bicarbonate before the use of irinotecan for 4 days; the control group did not receive any prevention. The use of gentamycin and sodium bicarbonate resulted in signifi-cantly higher stool pH (P<0.001), while the incidence of diarrhea by irinotecan was reduced (prevention group 13.70% versus control group 34.83%; P<0.001). Genta-mycin combined with sodium bicarbonate appears to be useful in preventing the diarrhea induced by irinotecan and reducing the dosage of loperamide and fluid replacement.