Antibiotics’s interactions In

gynecology
By The pharmacist Mohammed Ibrahim hussain
Introduction
• Antibiotics are chemical compounds used to treat or prevent some types
of bacterial infection.
They work by killing bacteria (bactericidal) or preventing them from
spreading (bacteriostatic) by many different mechanisms focused mainly on
disrupt essential processes or structures in the bacterial cell (Inhibition of
bacterial cell wall synthesis or bacterial protein synthesis(
 Introduction
• There are many types of infections affect the body including:
1. Viral infections
2. Fungal infections
3. Parasitic infections
4. Bacterial infection
Bacterial infections
• Infections can result from bacteria entering the body, increase in number,
and cause a reaction in the body.
• Bacteria can enter the body through an opening in your skin, such as a cut
or a surgical wound, or through your airway and cause infections.
• Unfortunately because of the low sterilization process in hospitals there is
a high risk of infections for every recumbent patient which is called
nosocomial infections.
Antibiotic classifications
1. Cephalosporins (Ceftriaxone, cefixime, cefotaxime, cefuroxime... etc(
2. Aminoglycosides(Gentamicin, amikacin ... etc(
3. Tetracyclines(Tetracycline, Doxycycline
4. Sulfonamides(Sulfasalazine, Sulfamethoxazole in combination with trimethoprim.. etc)
5. Penicillins(Amoxicillin, Piperacillin, Amoxicillin/clavulonic acid.. etc)
6. Fluoroquinolones(Ciprofloxacin, levofloxacin, Moxifloxacin... etc)
7. Carbapenems(Meropenem, Imipenem... etc)
8. Monobactams (aztreonam)
9. Rifamycins(Rifampin, Rifaximin... etc)
10. Oxazolidinones(Linezolid, Tedizolid)
11. Streptogramins (such as quinupristin and dalfopristin)
12. Polypeptides(Bacitracin, Colistin, Polymyxin)
• The most common prescribed antibiotics in hospitals Are :
1. Ceftriaxone (rocephin)
2. Gentamicin(garamycin)
3. Amoxicillin (amoxil)
4. Cefuroxemie (zamur)
5. Azithromycin
6. Ciprofloxacin(ciprodar)
7. metronidazole(flagyl)
 Antibiotic’s interactions
• Drug interaction can be defined as an interaction between a drug and
another substance that prevents the drug from performing as expected and
may result in an increase or decrease the effectiveness of the drugs or the
side effects of the drug.
 Ceftriaxone
• Considered a third generation antibiotic belong to cephalosporin and has a broad spectrum of
activity against Gram-positive and Gram-negative aerobic bacteria .
• Ceftriaxone dose is 1_2 g/24hrs for most infection
• Pregnancy category : B
• Ceftriaxone may have some serious interactions with many of drugs should be taken on
consideration including :
1. Contraindicated interactions( Calcium in any salt, Ringer solution, lactated ringer solution)
2. Serious – Use Alternative interactions (Enoxaparin, heparin, warfarin)
3. Monitor Closely interactions (doxycycline, tetracycline, erythromycin, conjugated estrogens)
4. Minor (furosemide)
Ceftriaxone interactions
• Ceftriaxone and calcium (gluconate,acetate,carbonate, chloride,citrate)
have a very dangerous complication potentially fatal particulate
precipitation in lungs and kidneys
• If there is a need for calcium after the administration of Ceftriaxone, the
solution is Separate administration by at least 48 hrs.
Ceftriaxone interactions
• Ceftriaxone and Enoxaparin, heparin and most of anticoagulants have a
serious interactions which is probably due to two reasons :
1. Ceftriaxone increases effect of enoxaparin by anticoagulation.
2. Cephalosporins may decrease prothrombin activity so decrease
Coagulation process.
Avoid or Use Alternative Drug should be done .
Case discussion
• The following patient was admitted to our hospital complaining from Nausea, Vomiting and abdominal pain
During pregnancy.
• One of dear doctors wrote for her a Ceftriaxone and Enoxaparin at same time together so our duty as a
pharmacists to provide the knowledge about this interaction, luckily the patient was allergic to ceftriaxone and
the antibiotic was changed to Amoxicillin
• The solution could be done is either to change the antibiotic or the anticoagulant so that no interactions occur
which can be done as :
1. Change Antibiotic to Amoxicillin, Amoxicillin /clavulonic acid, cefixime if there was a pregnancy Or use
Ciprofloxacin, levofloxacin and Doxycycline /Tetracyclines with minor drug interactions with Enoxaparin if
the patient was non pregnant
2. Use of Rivaroxaban as an alternative for Enoxaparin along with Ceftriaxone if there was an allergy or
resistance for other alternatives .
Gentamicin
• Gentamicin is the most commonly used aminoglycoside antibiotic and is indicated for moderate-to-severe
bacterial infections caused by sensitive gram negative bacteria by binding to bacterial ribosomes and
inhibiting protein synthesis.
• Dose of gentamicin is 3_5 mg/kg/dose every 8hrs for most of infections
• Pregnancy category : D
• Gentamicin have some interactions should be taken on consideration including :
1. Serious – Use Alternative interactions (furosemide, torsemide, bumetanide, bacitracin, bacitracin,
amphotericin B deoxycholate)
2. Monitor Closely interactions (mefenamic acid, estradiol, drospirenone, conjugated estrogens, albuterol,
loratadine, NSAIDS and others)
3. Minor drug interactions (thiamine, meclizine, magnesium, calcium, biotin)
Amoxicillin
• Amoxicillin is one of the most commonly used antibiotics in the primary care
setting with a broad spectrum of activity against Gram-positive and Gram-negative
bacteria, its bactericidal activity due to inhibiting the biosynthesis and repair of the
bacterial mucopeptide wall.
• Pregnancy category : B
• Dose of Amoxicillin :
• Mild to moderate infections : 500 mg PO q12hr or 250 mg PO q8hr for 10-14 days
• Severe infections : 875 mg PO q12hr or 500 mg PO q8hr
Amoxicillin interactions
• Amoxicillin have some interactions should be taken on consideration
including :
1. Serious – Use Alternative interactions (doxycycline, tetracycline,
mycophenolate)
2. Monitor Closely interactions (acyclovir, allopurinol,ethinyl estradiol,
dienogest/estradiol valerate, aspirin)
3. Minor interactions (azithromycin, pyridoxine)
Cefuroxime
• Cefuroxime is broad-spectrum second-generation cephalosporin has an activity against gram-
negative and some activity gram-positive bacteria.
• Dose of cefuroxime is 250-500 mg PO q12hr for 10 days for most of infections
• Pregnancy category : B
• Cefuroxime has some interactions should be taken on consideration including :
1. Serious – Use Alternative interactions (enoxaparin, heparin)
2. Monitor Closely interactions (calcium carbonate, esomeprazole and most of PPIs,
doxycycline, ethinyl estradiol, dienogest/estradiol valerate)
3. Minor interactions (chloramphenicol, choline magnesium trisalicylate)
Azithromycin
• regimendmycin is a broad-spectrum macrolide antibiotic with a long half-life
and a high degree of tissue penetration with a broad spectrum of activity
against gram positive and some community-acquired Gram-negative
pathogens.
• There is two regimens of treatment of Azithromycin :
• 3 days regimen : 500 mg PO qDay
• 5days regimen:500 mg PO in first day then 250mg qDay for 4 days
• Pregnancy category : B
Azithromycin interactions
• Azithromycin may have some interactions should be taken on
consideration including :
1. Serious - Use Alternative interactions (ondansetron, enoxaparin, heparin,
albuterol)
2. Monitor Closely interactions (itraconazole, ketoconazole, sodium
bicarbonate, estrogens conjugated synthetic, cephalosporin)
3. Minor interactions(amoxicillin, levofloxacin, trimethoprim)
Ciprofloxacin
• Ciprofloxacin is a second generation broad spectrum fluoroquinolone active
against both Gram-positive and Gram-negative bacteria with a high oral
bioavailability and a large volume of distribution
• Dose of ciprofloxacin is :
• Mild/moderate infections : 500 mg PO q12hr or 400 mg IV q12h
• Severe/complicated infections : 750 mg PO q12hr or 400mg IV q12h
• For 7_14 days mostly
• Pregnancy category : C
Ciprofloxacin interactions
• Ciprofloxacin may have some interactions should be taken on
consideration including :
1. Serious – Use Alternative interactions (theophylline, tretinoin,
clarithromycin, ondansetron)
2. Monitor Closely interactions (metform,tinidazole, mefenamic
acid,ferrous gluconate, ferrous sulfate, ferrous gluconate, estradiol,
donepezil)
3. Minor interactions (pyridoxine, thiamin, diazepam)
Metronidazole
• Metronidazole has antiprotozoan and antibacterial effects , also used to
treat anaerobic infections that do not require oxygen to grow and multiply
• Metronidazole used widely by gynecologists dor amebiasis, giardiasis,
nonspecific vaginitis, and anaerobic infections, including upper genital
tract infections.
• Dose of metronidazole is 250_500mg q8_12hrs for 5_10days
• Pregnancy category : B
Metronidazole interactions
• Metronidazole may have some interactions should be taken on
consideration including :
1. Serious – Use Alternative interactions (mebendazole, erythromycin(
2. Monitor Closely interactions ( clopidogrel, dexamethasone, loratadine,
conjugated estrogens, estradiol)
3. Minor interactions (acetaminophen, itraconazole, ketoconazole,
finasteride)
 Thank you

By pharmacist Mohammed Ibrahim hussain