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IJCS 2018; 6(2): 2120-2122 Drug interactions with antibiotics
© 2018 IJCS
Received: 20-01-2018
Accepted: 23-02-2018
Sushree Sangita Mohapatra, Arjun Kafle, Indrapal Reddy and Jadav
Sushree Sangita Mohapatra
Sarma
Teaching Assistant, Department
of Pharmacology and Abstract
Toxicology, College of Veterinary When two or more drugs enter simultaneously to the systemic circulation, they interact with each other
science, Proddatur, Andhra and may exhibit synergistic, antagonistic or additive effect. Antagonistic effect may reduce the
Pradesh, India therapeutic index of the drugs. Additive effect may sometimes cause overdose. Synergistic activity may
increase the potency. This article is solely dedicated to show some of the drug interactions with
Arjun Kafle
antibiotics.
Veterinary Officer, Sri Anantha
Padmanabha Swamy Pharma
Pvt Ltd., India Keywords: Drug interactions, synergistic, additive, antagonistic activity
Methamine, in acidic urine breaks down into formaldehyde aminoglycosides for peritonitis after intestinal spillage,
and forms insoluble precipitate with certain sulphonamide and combination of macrolide with fluoroquinolones or
increase the chance of crystalluria in the urine. Sulphonamide aminoglycoside can be synergistic, antagonistic or indifferent,
as bacteriostatic drug decreases the action of penicillins which depending on the micro-organism studied (Gigure et al.,
is bactericidal in nature [4]. 2006). Combination of macrolide with rifampin gave
synergistic inhibition of Rhodococcus equi (Prescott and
Beta-lactam Antibiotics Nicolson, 1984).
Combination of beta-lactam antibiotics with aminoglycosides Erythromycin and many other macrolides lead to inactivation
synergizes the activity of aminoglycosides by helping the of the CYP 450 enzyme complex. Concurrent use of
aminoglycoside to pass through the bacterial cell membrane. erythromycin increases concentrations of drug that are
[5-10]
. Combination of parenteral penicillin with heparin causes primarily dependent upon CYP3A metabolism such as
coagulopathies [11-17]. The mechanism of coagulopathies may theophylline, midazolam, carbamazapine, omeprazole and
be due to the direct effect of the penicillin on the platelets ranitidine. Clarithromycin and roxitrhromycin have lower
when combined with heparin it exhibits the additive effect [12, affinity for P450 system than erythromycin and other classic
13, 17]
. With the concurrent use of aspirin with penicillin group macrolide (except spiramycin) (Gigure et al., 2006).
of antibiotics such as oxacillin, nafcillin, cloxacillin, and
dicloxacillin increases the half-life and serum concentrations. Aminoglycosides
Concurrent administration of chloramphenicol (bacteriostatic) Aminoglycosides normally exhibits additive and sometimes
with penicillin may antagonize the action of penicillin group synergistic with beta-lactam antibiotics. When the
of drugs [18, 19]. Concurrent use of cephalosporin group of aminoglycosides are combined with beta lactam antibiotics,
drugs with antacids decreases the concentrations of antibiotics they show synergistic activity against streptococci,
in blood. Concurrent administration of salicylates, enterococci, pseudomonas and other gram-negative bacteria
phenylbutazone, and sulphonamides along with penicillins (Winstanley et al., 1989). Gentamicin exhibits synergistic
results in displacement of penicillins from their plasma activity against the gram-positive bacteria like Rhodococcus
protein binding sites. Penicillin on administration with equi and Listeria monocytogenes. The reason behind this is
probenecid or other weak organic acids, is competitively mainly beta-lactam antibiotics disrupt the cell wall which
inhibited of tubular secretion and therefore increasing the makes aminoglycosides to pass into the bacterial cytoplasm
plasma half life and blood concentrations of penicillin. Acid and exhibit its action. Aminoglycosides have some physical
susceptible penicillins such as penicillin-G should not be characteristics like highly polar in nature and therefore they
administered with normal saline or acidic pH parenteral fluids are incompatible with beta-lactam antibiotics when combined
because they are inactivated by the acidic pH. in the syringe. Therefore care must be taken to avoid mixing
of aminoglycosides with other drugs inside the syringe
Peptide Antibiotics (Gigure et al., 2006). Combination of lincomycin with
Polymyxin spectinomycin enhances the spectinomycin’s activity against
Polymyxin group of antibiotics shows synergism with the mycoplasma and Lawsonia intracellularies. Loop diuretics
sulphonamides and trimethoprim against various and osmotic diuretics aggravate the nephrotoxicity when
enterobacteriaceae. Colistin is synergistic in vivo with concurrently administered with aminoglycosides. Risk of
rifampin or cefdizime against multidrug resistant P. respiratory paralysis and neuromuscular blockade increases
aeruginosa (Giamerellos-Bourboulis et al., 2003). with concurrent administration of aminoglycosides and
neuromuscular blocking drugs. Aminoglycosides and
Vancomycin halothane together increase the risk of cardiovascular
These are the glycoprotein group of drugs which have depression. Cephalosporin and aminoglycosides are
synergistic action with aminoglycosides against Gram- contraindicated together because of their nephrotoxicity [3].
positive cocci. It appears to be synergistic in vivo with
rifampin against staphylococcus aureus. (Gigure et al., 2006) Tetracyclines
Calcium, calcium containing IV fluids (ringer lactate),
Lincosamides magnesium, and aluminum containing antacids impairs the
Combination with spectinomycin appears to give marginally absorption of tetracyclines. Iron containing preparations and
enhanced activity against mycoplasma in vitro. Clindamycin bismuth subsalicylate also hinder the absorption of the
is commonly combined with and aminoglycoside or tetracyclines (tetracycline chelates with divalent and trivalent
fluoroquinolone in human medicine to treat or prevent mixed cations which is the phenomenon of chemical antagonism).
aerobic and anaerobic bacterial infection. Particularly these Tetracycline and tylosin exhibit synergistic activity against
are associated with intestinal spillage into peritoneum. The Pasteurella. In combination with polymyxin, tetracycline
combination generally has additive or synergistic effects in exhibits the synergistic activity because polymyxin increases
vitro against a wide range of bacteria. Clindamycin has the tetracycline uptake into the bacterial cell wall. (Gigure et
synergistic effects with metronidazole against B. fragilis but al., 2006)
only additive effects with trimethoprim–sulphamethoxazole Tetracycline antagonizes the action of beta-lactam antibiotics
combination against common gram-negative or gram-positive (bacteriostatic drugs inhibits the growth of bacteria and the
aerobes. Combination with macrolids or chloramphenicol is bactericidal drugs act only upon growing bacteria). Oral
antagonistic in vitro. (Gigure et al., 2006) anticoagulants and tetracyclines if administered concurrently,
then they may aggravate bleeding by depressing plasma
Macrolids prothrombin activity. Microsomal enzyme inducers like
Combination of erythromycin with other macrolids, phenytoin and Phenobarbital may decrease the plasma half
Lincosamides, chloramphenicol is antagonistic in vitro. lives of lipid soluble tetracyclines by increasing their
Erythromycin has been used alone or with an metabolism [3].
~ 2121 ~
International Journal of Chemical Studies
~ 2122 ~