Pharmacokinetic Drug Interactions of Antimicrobial Drugs: A Systematic Review on Oxazolidinones, Rifamycines, Macrolides, Fluoroquinolones, and Beta-Lactams

Abstract

Like any other drug, antimicrobial drugs are prone to pharmacokinetic drug interactions. These drug interactions are a major concern in clinical practice as they may have an effect on efficacy and toxicity. This article provides an overview of all published pharmacokinetic studies on drug interactions of the commonly prescribed antimicrobial drugs oxazolidinones, rifamycines, macrolides, fluoroquinolones, and beta-lactams, focusing on systematic research. We describe drug-food and drug-drug interaction studies in humans, affecting antimicrobial drugs as well as concomitantly administered drugs. Since knowledge about mechanisms is of paramount importance for adequate management of drug interactions, the most plausible underlying mechanism of the drug interaction is provided when available. This overview can be used in daily practice to support the management of pharmacokinetic drug interactions of antimicrobial drugs.

Optimal Antimalarial Dose Regimens for Sulfadoxine-Pyrimethamine with or without Azithromycin in Pregnancy Based on Population Pharmacokinetic Modeling

“…In addition, the effect of pregnancy on AZI clearance was not observed in those women given AZI, suggesting maximal induction of metabolizing enzymes or effect on cellular transporters that are only partially increased with pregnancy. Although AZI has fewer interactions than other macrolides, interactions with antihistamines, calcineurin inhibitors, sulfonylureas, and ivermectin have been reported (32,33). The exact mechanisms of these interactions have not been defined, but they are more likely be mediated through inhibition or induction of drug transporters such as P-glycoprotein and organic anion-transporting polypeptide (64) rather than metabolizing enzyme systems since AZI has limited effects on CYP enzymes (32,33).…”

“…Since AZI is safe in pregnancy (25,26), the potential of SP combined with AZI (SP-AZI) as IPTp has been investigated in several studies, but the results have been variable (27)(28)(29)(30)(31). Although AZI has fewer interactions than related macrolide antibiotics (32,33), a possible explanation for the inconsistent efficacy of SP-AZI is that AZI has a clinically significant interaction with one or other of the components of SP (32). There have, however, been no comparative studies of the pharmacokinetics of AZI and SP alone and in combination in either nonpregnant patients or pregnant women.…”

Seguridad de las fluoroquinolonas: riesgos habitualmente olvidados para el clínico

“…Se ha postulado desplazamiento del anticoagulante de la unión a proteínas plasmáticas, inhibición de citocromo y disrupción de la microbiota intestinal que sintetiza vitamina K; por lo que su mecanismo involucra interacción farmacocinética y farmacodinámica 46 . Se aconseja una monitorización frecuente del INR durante y justo después de la administración concomitante con una quinolona con un agente anticoagulante oral 45 . Otras interacciones farmacodinámicas involucran potenciación del …”

Alteration of the Disposition of Quinine in Healthy Volunteers After Concurrent Ciprofloxacin Administration

“…7,8 Antimicrobials are one of the most commonly prescribed classes of medications all over the world, 9 and these drugs are associated with many significant druginteraction activity as both inducers and inhibitors of enzymes. 10 Coexistence of malarial and bacterial infections is common in tropical regions, particularly in Africa. 11 As a result of this, antimalarials and antibiotics are usually prescribed together, and coadministration of these 2 classes of antiinfectives is inevitable in most instances.…”