April 3, 2017

Caution Urged When Prescribing Antibiotics Concomitantly With Psychotropics in Elderly Patients

By Thomas S. May

FLORENCE, Italy -- April 3, 2017 -- Drug-drug interactions (DDIs) between antibiotics and psychopharmaceuticals, which frequently occur in elderly patients with mood disorders and infections, can be minimised with careful selection of these drugs, according to a study presented here on April 2 at the 25th European Congress of Psychiatry (EPA).

“Antibiotics have several drug-drug interactions with psychotropic drugs that can lead to adverse events or treatment failure and significantly increase the costs of treatment,” said Matej Stuhec, PhD, University of Ljubljana, Ljubljana, Slovenia. “Many patients with mood disorders are treated with antibiotics concomitantly, and therefore there is a need for prudent antibiotic prescribing to avoid serious harms and important DDIs with psychotropics.”

For the study, the researchers retrospective analysed data from 233 older adults who received antibiotics and psychotropic medications in Slovenian nursing homes. Patients’ charts were used to identify major and minor DDIs, according to interaction classes described by Lexicomp Online (version 19).

Results showed that the average number of medications per patient was 10.9 and 72 patients (30.9%) had at least 1 major DDI, while 172 patients (73.8%) had at least 1 minor interaction.

Of the 27 patients (11.5%) who were treated for at least 1 major DDI, 17 were taking ciprofloxacin, 6 moxifloxacin, 3 azithromycin, and 1 levofloxacin. The most frequent DDIs were observed between quetiapine and ciprofloxacin, which occurred in 12 patients. Most (n = 27) DDIs were pharmacodynamic interactions, resulting in QTc prolongation.

On the basis of these results, the investigators concluded that DDIs occur very often between antibiotics and psychotropic drugs. They also recommended that, if an antidepressant must be used in patients with mood disorders and infection, physicians should prescribe sertraline instead of escitalopram, venlafaxine instead of duloxetine, and mirtazapine instead of quetiapine.

“We also recommend the use of a penicillin instead of ciprofloxacin and azithromycin in patients with mood disorders for infection treatment,” the researchers added.

[Presentation title: Drug-Drug Interactions Between Antibiotics and Psychopharmaceuticals in Slovenian Nursing Homes: a Retrospective Observational Cohort Study From a National Perspective. Abstract ED205]
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