Coadministration of Oral Levofloxacin With Agents That Impair Absorption: Impact on Antibiotic Resistance

Cohen, Keira A.; Lautenbach, Ebbing; Weiner, Mark G.; Synnestvedt, Marie; Gasink, Leanne B.

doi:10.1086/590666

Cited by 19 publications

(8 citation statements)

References 8 publications

(10 reference statements)

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“…St. John's wort, a widely used herbal supplement as an antidepressant, is associated with numerous drug interactions (Zhou and Lai, 2008). Also, drug interactions can be dose or time dependent interactions (Cohen et al, 2008, Schachter, 2005). For example, it’s highly recommended to limit the dose of simvastatin to 20 mg per day when co-administered with amlodipine or diltiazem to halt the incidence of myopathy (Schachter, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…For example, it’s highly recommended to limit the dose of simvastatin to 20 mg per day when co-administered with amlodipine or diltiazem to halt the incidence of myopathy (Schachter, 2005). It’s also recommended to separate the administration time of oral fluoroquinolones and oral divalent or trivalent cation-containing compounds to prevent the antibiotic failure (Cohen et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of community pharmacists’ knowledge about drug–drug interaction in Central Saudi Arabia

Alrabiah

Arifi

Alghadeer

et al. 2019

Saudi Pharmaceutical Journal

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IntroductionAlthough all implemented and ongoing initiatives, drug-drug interactions (DDIs) are still a global problem. Most published studies about DDIs in Saudi Arabia are carried out in hospital settings. In addition, assessing the knowledge of drug interactions in Saudi Arabia is limited. The aim of our study is to evaluate the knowledge of potential common drug-drug interactions among community pharmacists particularly in Saudi Arabia.MethodologyA crosses-sectional study utilizing a self- administered questionnaire was conducted among community pharmacy in Riyadh city Saudi Arabia. DDIs' knowledge was assessed by 26 drug pairs. Community pharmacists were asked to select the DDIs as “contraindication”, “may be used together with monitoring”, “no interaction” and “not sure”.ResultsA total of 283 of community pharmacists completed the survey with response rate of 80.9%. Among the 26 drug pairs only 5 of them were identified correctly by most of the participants. To add more 3 out of the 5 pairs had a cutoff of less than 10% between the correct and wrong answer, meaning there still a majority that couldn't identify the correct answer. All the 26 pairs had a statistically significant difference between the correct and incorrect answer.ConclusionThe results of this study showed that knowledge of community pharmacists about DDIs was inadequate. Community pharmacist should have specific courses in drug interactions to cover the most possible interactions that can be seen in this setting.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of community pharmacists’ knowledge about drug–drug interaction in Central Saudi Arabia

Alrabiah

Arifi

Alghadeer

et al. 2019

Saudi Pharmaceutical Journal

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“…On multivariate analysis, the ORs for resistant pathogens with 100% (vs. <100%), ³ 50% (vs. <50%), and 100% (vs. 0) coadministration were significant (OR, 1.43; p = 0.03; OR, 1.52; p = 0.006; and OR, 1.36; p = 0.05; respectively). For ³ 75% (vs. <75%) and ³ 25% (vs. <25%) coadministration, statistical significance was not achieved [121].…”

Section: Therapeutic Implications Of Absorption Interactionsmentioning

confidence: 91%

Quinolones

Guay¹

2011

Drug Interactions in Infectious Diseases

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Fluoroquinolone (FQ) antimicrobials are among the most commonly used agents in the outpatient and institutional patient care environments. Due to this high frequency of utilization, the potential for deleterious drug-drug interactions with nonantimicrobials is also high. The majority of interactions with the FQs involve deleterious effects on the FQ component. These are also the most clinically-important interactions with these agents. Multivalent cations such as Mg , and other minerals as well as drugs such as sucralfate, lanthanum, sevelamer, and didanosine (the cation-supplemented version of the latter) can substantially reduce FQ bioavailability, leading the subtherapeutic drug concentrations at the infection site and clinical failure. Separation of dose administrations may or may not reduce the magnitude of these interactions. Ciprofloxacin, norfloxacin, and two experimental FQs in clinical trials (pazufloxacin and prulifloxacin) act as moderate cytochrome P450 enzyme inhibitors and may increase serum concentrations of theophylline and caffeine. Warfarin pharmacodynamics are variably affected by the FQs. The pharmacodynamic interactions between NSAIDs and FQs are only relevant if fenbufen is used concurrently with enoxacin or, possibly, prulifloxacin. Caution is warranted if sparfloxacin or moxifloxacin is used concurrently with other medications prolonging the QTc interval or if patients have other risk factors for prolongation of the QTc interval (e.g. abnormal QTc interval pre-treatment, electrolyte abnormalities, use of starvation-liquid diets, or history of heart disease). Fluoroquinolone antimicrobials can be used effectively and safely in the vast majority of patients if the clinician remembers those few drug-drug interactions that are clinically-important.

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“…Among 3,134 patients who received a course of oral LVX, coadministration was significantly associated with subsequent identification of an LVX-resistant isolate 45. Strategies to curb the emergence of LVX resistance should include avoiding coadministration of divalent or trivalent cation-containing compounds and LVX.…”

Section: Drug–drug Interactionsmentioning

confidence: 99%

Personalized therapeutics for levofloxacin: a focus on pharmacokinetic concerns

Gao¹,

Yu²,

Zeng³

et al. 2014

TCRM

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BackgroundPersonalized medicine should be encouraged because patients are complex, and this complexity results from biological, medical (eg, demographics, genetics, polypharmacy, and multimorbidities), socioeconomic, and cultural factors. Levofloxacin (LVX) is a broad-spectrum fluoroquinolone antibiotic. Awareness of personalized therapeutics for LVX seems to be poor in clinical practice, and is reflected in prescribing patterns. Pharmacokinetic–pharmacodynamic studies have raised concerns about suboptimal patient outcomes with the use of LVX for some Gram-negative infections. Meanwhile, new findings in LVX therapeutics have only been sporadically reported in recent years. Therefore, an updated review on personalized LVX treatment with a focus on pharmacokinetic concerns is necessary.MethodsRelevant literature was identified by performing a PubMed search covering the period from January 1993 to December 2013. We included studies describing dosage adjustment and factors determining LVX pharmacokinetics, or pharmacokinetic–pharmacodynamic studies exploring how best to prevent the emergence of resistance to LVX. The full text of each included article was critically reviewed, and data interpretation was performed.ResultsIn addition to limiting the use of fluoroquinolones, measures such as reducing the breakpoints for antimicrobial susceptibility testing, choice of high-dose short-course of once-daily LVX regimen, and tailoring LVX dose in special patient populations help to achieve the validated pharmacokinetic–pharmacodynamic target and combat the increasing LVX resistance. Obese individuals with normal renal function cleared LVX more efficiently than normal-weight individuals. Compared with the scenario in healthy subjects, standard 2-hour spacing of calcium formulations and oral LVX was insufficient to prevent a chelation interaction in cystic fibrosis patients. Inconsistent conclusions were derived from studies of the influence of sex on the pharmacokinetics of LVX, which might be associated with sample size and administration route. Children younger than 5 years cleared LVX nearly twice as fast as adults. Patients in intensive care receiving LVX therapy showed significant pharmacokinetic differences compared with healthy subjects. Creatinine clearance explained most of the population variance in the plasma clearance of LVX. Switching from intravenous to oral delivery of LVX had economic benefits. Addition of tamsulosin to the LVX regimen was beneficial for patients with bacterial prostatitis because tamsulosin could increase the maximal concentration of LVX in prostatic tissue. Coadministration of multivalent cation-containing drugs and LVX should be avoided. For patients receiving warfarin and LVX concomitantly, caution is needed regarding potential changes in the international normalized ratio; however, it is unnecessary to seek alternatives to LVX for the sake of avoiding drug interaction with warfarin. It is unnecessary to proactively reduce the dose of cyclosporin or tacrolimus when comedicated with LVX. Tr...

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Coadministration of Oral Levofloxacin With Agents That Impair Absorption: Impact on Antibiotic Resistance

Cited by 19 publications

References 8 publications

Evaluation of community pharmacists’ knowledge about drug–drug interaction in Central Saudi Arabia

Evaluation of community pharmacists’ knowledge about drug–drug interaction in Central Saudi Arabia

Quinolones

Personalized therapeutics for levofloxacin: a focus on pharmacokinetic concerns

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