Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 12) potx

Treatment and Prophylaxis of Bacterial Infections Part 12 Drug Interactions Antimicrobial drugs are a common cause of drug-drug interactions.. Table 127-8 lists the most common and be

Chapter 127 Treatment and Prophylaxis

of Bacterial Infections

(Part 12)

Drug Interactions

Antimicrobial drugs are a common cause of drug-drug interactions Table 127-8 lists the most common and best-documented interactions of antibacterial agents with other drugs and characterizes the clinical relevance of these interactions Coadministration of drugs paired in the tables does not necessarily result in clinically important adverse consequences Recognition of the potential for an interaction before the administration of an antibacterial agent is crucial to the rational use of these drugs, since adverse consequences can often be prevented

if the interaction is anticipated Table 127-8 is intended only to heighten awareness of the potential for an interaction Additional sources should be consulted to identify appropriate options For further discussion of drug interactions, see Chap 5

Table 127-8 Interactions of Antibacterial Agents with Other Drugs

Consequence (Clinical Significancea)

Theophylline Theophylline

toxicity (1)

Erythromycin/clarithromycin/

telithromycin

Carbamazepine CNS

depression (1)

toxicity (2)

zolam

CNS depression (2)

Warfarin Bleeding (2)

crolimus

Nephrotoxicit

y (1)

arrhythmias (1)

sis (2)

toxicity (2)

lastine

Excess neurotoxicity (2)

Quinupristin/dalfopristin Similar to

erythromycinc

Fluoroquinolones Theophylline Theophylline

toxicity (2)d

ate/iron

Subtherapeuti

c antibiotic levels (1)

ate/iron

Subtherapeuti

c antibiotic levels (1)

toxicity (2)

Trimethoprim-sulfamethoxazole

Oral hypoglycemics

Hypoglycemi

a (2)

toxicity (2)

Metronidazole Ethanol

Disulfiram-like reactions (2)

suppression (1)

formation (1)

contraceptives

Pregnancy (1)

crolimus

Rejection (1)

inhibitors

Increased viral load, resistance (1)

Nonnucleoside

reverse-transcriptase inhibitors

Increased viral load, resistance (1)

steroid effect (1)

withdrawal symptoms (1)

c digoxin levels (1)

c itraconazole levels (1)

seizure control (1)

Statins Hypercholeste

rolemia (1)

c diltiazem levels (1)

c verapamil levels (1)

a

1 = a well-documented interaction with clinically important consequences;

2 = an interaction of uncertain frequency but of potential clinical importance

b

Lovastatin and simvastatin are most affected; pravastatin and atorvastatin are less prone to clinically important effects

c

The macrolide antibiotics and quinupristin/dalfopristin inhibit the same human metabolic enzyme, CYP3A4, and similar interactions are anticipated

d

Ciprofloxacin only Levofloxacin and moxifloxacin do not inhibit theophylline metabolism

Note: New interactions are commonly reported after marketing Consult the

most recent prescribing information for updates

Abbreviation: CNS, central nervous system