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Antibiotics - Interactions and Warnings

This study suggests that the frequency of antibiotic-associated coagulopathy is low, regardless of antibiotic, in patients who are not critically ill and not malnourished.
- Pharmacotherapy 1989;9(3):158-64 -- Prospective surveillance of antibiotic-associated coagulopathy in 970 patients. -- Grasela TH Jr, Walawander CA, Welage LS, Wing PE, Scarafoni DJ, Caldwell JW, Noguchi JK, Schentag JJ.

Malnourished patients with low serum vitamin K1 levels are at risk of developing hypoprothrombinaemia following intravenous antibiotic therapy.
- Br J Haematol 1988 Jan;68(1):63-6 -- The development of hypoprothrombinaemia following antibiotic therapy in malnourished patients with low serum vitamin K1 levels. -- Cohen H, Scott SD, Mackie IJ, Shearer M, Bax R, Karran SJ, Machin SJ.

The authors reviewed reported cases of antibiotic-induced manic episodes. Cases reported by the FDA showed clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania. Statistical analysis of the data would not have demonstrated a significant statistical correlative risk and was therefore not undertaken. Patients have an increased risk of developing mania while being treated with antimicrobials. Although this is not a statistically significant risk, physicians must be aware of the effect and reversibility. Further research clearly is required to determine the incidence of antimicrobial-induced mania, the relative risk factors of developing an antimicrobial-induced manic episode among various demographic populations, and the incidence of patients who continue to have persistent affective disorders once the initial episode, which occurs while the patient is taking antibiotics, subsides.
- J Clin Psychopharmacol 2002 Feb;22(1):71-81 -- Antimicrobial-induced mania (antibiomania): a review of spontaneous reports. -- Abouesh A, Stone C, Hobbs WR.

Several cases of pyloric stenosis have occurred in infants treated with erythromycin during the first weeks of life. A disturbing report of a cluster of cases is enough to avoid erythromycin use in neonates.
- Prescrire Int 2001 Feb;10(51):16 -- Erythromycin-induced pyloric stenosis in infants.

Concluded that erythromycin can markedly increase the systemic bioavailability of bromocriptine, which can lead to increased therapeutic or adverse effects.
- Clin Pharmacol Ther 1990 Jun;47(6):694-7 -- Pharmacokinetic evaluation of erythromycin and caffeine administered with bromocriptine. -- Nelson MV, Berchou RC, Kareti D, LeWitt PA.

Rifamycins [rifampicin (rifampin) more than rifabutin] induce cytochrome P450 enzymes and accelerate the metabolism of clarithromycin and HIV protease inhibitors. Conversely, clarithromycin inhibits these enzymes, resulting in increased rifabutin toxicity.
- Drug Saf 1999 Aug;21(2):137-52 -- Risk-benefit assessment of therapies for Mycobacterium avium complex infections. -- Griffith DE.

Please see: Amoxicillin; Cephalosporins; Ethambutol;
Fluoroquinolones; Isoniazid; Nitrofurantoin;
Rifampin; Tetracyclines; Trimethoprim/Sulfamethoxazole

last update: November 2008

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