Drug interactions with azithromycin and the macrolides: an overview

Abstract

Evidence interactions between individual macrolides and a number of pharmacologically active compounds that are frequently co-administered to patients with bacterial infections is reviewed. Theophylline is strongly associated with erythromycin interaction; clarithromycin may also interact with this drug. Azithromycin, spiramycin and rokitamycin, however, do not appear to have any effect on theophylline pharmacokinetics. The other therapeutic agents considered are cyclosporin, the antiepileptics, carbamazepine and phenytoin, terfenadine, warfarin, oral contraceptives, agents used in the management of gastritis and peptic ulcer and zidovudine. With the exception of interaction with antacids, there is no evidence that azithromycin, unlike most other macrolides, interacts with any of these agents to produce clinically significant adverse effects. The explanation for this variation appears to be azithromycin's inability to induce and bind to the cytochrome P450 IIIA enzyme system.

Macrolide resistance mechanisms inEnterobacteriaceae: Focus on azithromycin

“…or Salmonella enterica serovar Typhi (Erdman et al, 2008;Trivedi & Shah, 2012), and it is also used in the treatment of children and traveler's infections as an alternative to the usual antimicrobial agents (Basualdo, 2003;DuPont, 2009). Interestingly, unlike other macrolides, has shown no interactions with a series of drugs including antiretroviral agents such as zidovudine (Chave et al, 1992;Nahata, 1996). This fact, together with its broad spectrum and safety, has led to azithromycin being proposed and considered as an alternative to cotrimoxazole in areas with endemic HIV1 in low and middle-income countries when antibiotic prophylaxis is needed in HIV patients (Van Oosterhout et al, 2005).…”

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

“…Azithromycin has no effect on theophylline clearance because of the absence of interactions with cytochrome P450. 142 Theophylline should be used for children with severe acute asthma exacerbation with impeding respiratory failure, or those on mechanical ventilation who are already getting other bronchodilator or anti-inflammatory therapies.…”

Role of Therapeutic Drug Monitoring in Pulmonary Infections: Use and Potential for Expanded Use of Dried Blood Spot Samples

“…Caution is required when using clavulanic acid in 274 patients with hepatic impairment [31]. Because of their lack of metabolism by the CYP450 isoenzym 275 system, there are no important drug-drug interactions with drugs inducing or inhibiting these 276 enzymes that influence the pharmacokinetic profile of the beta-lactam antibiotics [24,28,32].…”

“…No data CYP450 inhibition [31] Not recommended [5] N azithromycin oral N(R) [6], AUC/MIC [32] CYP3A4 [19] LT [38], No(H) [39] No important mechanisms [39] Only in special populations [28,39] vancomycin IV Y(R)(H) [28] Drugs influencing the Commonly accepted renal clearance [5] [28]…”