Antibiotics and Lipid-Modifying Agents: Potential Drug-Drug Interactions and Their Clinical Implications

Abstract

Evidence-based prescribing requires taking into consideration the many aspects of optimal drug administration (e.g., dosage, comorbidities, co-administered drugs, etc.). A key issue is the administration of drugs for acute disorders that may potentially interfere with previously prescribed long-term medications. Initiating an antibiotic for an acute bacterial infection constitutes a common example. Hence, appropriate knowledge and awareness of the potential DDIs of antibiotics would lead to proper adjustments, thus preventing over- or under-treatment. For example, some statins, which are the most prescribed lipid-modifying agent (LMA), can lead to clinically important drug-drug interactions (DDIs) with the concurrent administration of antibiotics, e.g., macrolides. This review discusses the clinically significant DDIs of antibiotics associated with co-administrated lipid-lowering therapy and highlights common cases where regimen modifications may or may not be necessary.

Keywords: antibiotic stewardship; antibiotics; drug–drug interactions; good prescribing practices; lipid-modifying agents; pharmaceutical care.

Figure 1

Potential drug interaction mechanisms between lipid-modifying agents and antibiotics and the impact on the pharmacological and clinical outcome for LMAs.

Figure 2

A heat-map infographic of potentially clinically significant DDIs between statins and antibiotics (red: avoid co-administration; orange: dose adjustment or monitor; yellow: moderate–minor; green: no DDIs).

Figure 3

Examples of pharmacokinetic (PK) or pharmacodynamic (PD) drug–drug interactions (DDIs) of lipid-modifying agents (LMAs) and antibiotics along with potential clinical outcome (SUA: serious—use alternative).

Figure 4

Clinical considerations towards optimum prescribing practices when an antibiotic therapy is about to be initiated in a patient under treatment with LMAs.