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Antimicrobial Agents Drug Interactions: Insights and Considerations

This article by Prof. R. K. Dixit explores important drug interactions related to antimicrobials, covering aspects from manufacturing to administration. It delves into pharmacokinetic and pharmacodynamic considerations, highlighting synergisms, antagonisms, and specific interactions with drugs like Tetracyclines and Penicillins.

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Antimicrobial Agents Drug Interactions: Insights and Considerations

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  1. Antimicrobial Agents (General considerations) Prof. R. K. Dixit Pharmacology and Therapeutics K.G.M.U. Lucknow dixitkumarrakesh@gmail.com

  2. Objectives…. • Important drug interactions related to antimicrobials

  3. Important Drug Interactions of Antimicrobials Pharmaceutical • During manufacture, packaging, Storage • During drug administration • During Mixing and injecting drug • Mixing in oral solutions • Mixing in solvent, • In bottle, • No drug in • Blood, • Plasma and • Electrolyte solutions Pharmacokinetic (ADME) • Chlelation /(Antacids, Milk)- Tetracyclines • Alteration of pH/ Ionization of drug- Penicillins • Alteration with Enterohepatic recirculation- (OCP) • Inducer (Barbiturates, Rifampicin, Griseofulvin, Carbamazepine) • Inhibitor (Cimetidine, Chlolramphenicol, Erythromycin, Quinolones) • Protein biding displacement of drug (Important with high protein binding drugs)- Sulphonamides Pharmacodynamic • Synergism/Addition/ • Antagonism • Combinations of more than one antimicrobial • Combination of antimicrobial with other agents

  4. Important Drug Interactions of Antimicrobials Pharmaceutical • During Manufacture, Packaging, Storage • During drug administration • During Mixing and injecting drug (If Coagulate Reject) • Mixing in oral solutions (Not advisable) • Mixing in solvent (According to instructions) • No drug in • Blood, • Plasma and • Electrolyte solutions

  5. Important Drug Interactions of Antimicrobials Pharmacodynamic • Synergism/Addition(Cidal + Cidal, Static + Static) • Antagonism (Cidal + Static) When more sensitive to Cidal • Combination of antimicrobial with other agents

  6. Important Drug Interactions of Antimicrobials Pharmacokinetic (ADME) • Chelation /(Antacids, Milk)- • Tetracyclines • Alteration of pH/ Ionization of drug- • Penicillin G (not absorbed orally) • Alteration with Enterohepatic recirculation- • OCP with antimicrobials • Inducers- • Rifampicin, Griseofulvin, • Inhibitors- • Chlolramphenicol, Erythromycin, Quinolones (Grape fruit (Furanocoumarins) • Protein biding displacement of drug- • Sulphonamides

  7. List of Important Interactions Related to Antimicrobials

  8. Ethyl Alcohol – (Alcohol dehydrogenase or Acetaldehyde synthetase) Acetaldehyde- (Acetaldehyde dehydrogenase) Acetic Acid- Kreb’s cycle- ATP + CO2+ H2O (Blocked by Disulfiram)- Accumulation of Acetaldehyde and precipitations of syndrome consisting of Headache, Vomiting, Flushing etc.

  9. Thanks

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