Cefoxitin Interactions
Aminoglycosides
Anticoagulants
- Chloramphenicol
Macrolides
- Polymyxin B
- Probenecid
Tetracyclines
- Vancomycin
Cefoxitin Interactions
Probenecid competitively inhibits renal tubular secretion of cefoxitin, causing higher, prolonged serum levels of the drug.[6661] In general, this pharmacokinetic interaction is not harmful, and, in some cases, probenecid is intentionally administered with cefoxitin to achieve higher serum concentrations.
Concomitant use of cefoxitin and nephrotoxic drugs, such as vancomycin, polymyxin B, colistin, or aminoglycosides, can increase the risk of nephrotoxicity, although in general, cefoxitin is not signficantly nephrotoxic.[6661]
Concomitant use of cephalosporins and some bacteriostatic antibiotics, such as chloramphenicol, have interfered with the bactericidal activity of the cephalosporins. Many texts warn not to use bacteriostatic and bactericidal antibiotics together since the bactericidal actions of, for example, a penicillin may be inhibited by the bacteriostatic agent. The clinical significance of these interactions is debatable. The classic explanation of this antagonism is that the bacteriostatic antimicrobial agent inhibits the growth of the target organism, and interferes with the action of the bactericidal agent, which is dependent on cell growth/replication for proper activity.[5677] However, despite reports of pharmacologic antagonism in vitro with such combinations, few clinical data to substantiate in vivo antagonism exist.[5677] Combination antimicrobial therapy has been a useful strategy for treating clinical infections. For example, the concomitant clinical use of cephalosporins and tetracyclines (e.g., doxycycline) is common in some mixed bacterial infections without loss of clinical efficacy of either agent. Similarly, many mixed bacterial infections are treated safely and efficaciously with the concomitant administration of cephalosporins and macrolides (e.g., azithromycin, clarithromycin, erythromycin). Although the potential for antagonism should be considered when prescribing antibiotics, in general it is safe to administer combinations, refining treatment based on the nature of the clinical infection and individual parameters such as susceptibility data.
As with other cephalosporins, cefoxitin may have additive or synergistic activity with the aminoglycosides, aztreonam, carbapenems, and the penicillins in its bactericidal effects.
Cephalosporins have been associated with decreased prothrombin activity. Cephalosporins with a methylthiotetrazole (MTT) side ring (e.g., cefamandole, cefotetan, cefoperazone) are more frequently associated with hypoprothrombinemic activity. Decreased vitamin K activity due to depletion of gut flora may also be a contributing factor. Patients previously stabilized on anticoagulants may be at an increased risk for prolonged prothrombin time. Cephalosporins should be used cautiously when administered to patients already receiving anticoagulants.[5279] [6661]
[ Last revised: 11/29/2005 7:42:00 PM ]
References
. Coumadin® (warfarin) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2006 Oct.
. Cohn JR, Jungkind DL, Baker JS. In vitro antagonism by erythromycin of the bactericidal action of antimicrobial agents against common respiratory pathogens. Antimicrob Agents Chemother 1980;18:872 - 6.
. Mefoxin® (cefoxitin injection) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2003 Aug.
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