Cephalosporins
Summary
drug class: Cephalosporins
drugs and trade names:
• Cefuroxime: Ceftin®
• Cephalexin: Cefanex®, Keflet®, Keflex®, Keftab®
• Cefixime: Suprax®
• Cefpodoxime: Vantin®
• Cefprozil: Cefzil®
• Ceftriaxone: Rocephin®
• Cephadroxil: Duricef, Ultracef®
• Cephaclor: Ceclor®
• Loracarbef: Lorabid®
type of drug: Antibiotic.
used to treat: A wide variety of infections, including those of the skin, upper respiratory system (including otitis media), and genito-urinary tract.
overview of interactions:
• adverse drug effects: Probiotic Intestinal Flora
• nutrient affected by drug: Vitamin K
Interactions
adverse drug effects: Probiotic Intestinal Flora
• mechanism: During the course of eliminating disease-causing bacteria, antibiotics such as cephalosporins also usually destroy normally-occurring beneficial bacterial flora that form an integral part of the healthy intestinal ecology and assist digestive and immune functions. Diarrhea and yeast infections, including vaginal yeast, are common side-effects of the disruption of intestinal ecology and the creation of an environment more susceptible to proliferation of pathogenic levels of opportunistic yeast. In more serious cases, this diminished state of intestinal health could potentially permit overgrowth of
C. difficile, a bacteria responsible for pseudomembranous colitis. Patients who develop pseudomembranous colitis as a result of antibiotic treatment can experience diarrhea, abdominal pain, fever, and sometimes even shock.
• nutritional support: Supplementation of beneficial probiotic bacterial flora, such as
Lactobacillus acidophilus, Bifidobacterium bifidus and Lactobacillus cassei, preferably in the form of a varied, vigorous and abundant culture, will restore the healthy intestinal ecology and stabilize the mucosal lining of the gut. A supplemental dosage of at least one billion organisms per day is necessary to achieve the critical mass of bacterial restoration and successfully reinvigorate healthy intestinal ecology.
nutrient affected by drug: Vitamin K
• mechanism: Cephalosporins both undermine with vitamin K synthesis and interfere with its metabolism. Like any antibiotic, cephalosporins destroy the friendly bacterial flora of the intestines in the process of attacking pathogenic bacteria. One of the key functions of these probiotic bacteria in the digestive ecology is the synthesis of vitamin K synthesis. As a result of cephalosporin use, vitamin K synthesis is reduced until the bacteria are reinforced through the use of supplemental flora.
Cephalosporins also interferes directly with vitamin K metabolism, and as a result can lead to abnormal bleeding. (Anonymous.
Nutr Rev 1984;42(4):161-163)
• nutritional support: Conservative nutritional practice indicates the value of supplementing with vitamin K whenever cephalosporin is used. Generally, a multivitamin containing vitamin K may be adequate. However, if hemorrhage results from a cephalosporin antibiotic, a physician should be consulted for diagnosis and treatment. In such cases, vitamin K should initially be administered by IM injection.
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References
Anonymous. New examples of vitamin K-drug interaction. Nutr Rev 1984;42(4):161-163. (Review)
Breen GA, St Peter WL. Hypoprothrombinemia associated with cefmetazole. Ann Pharmacother 1997 Feb;31(2):180-184
Abstract: OBJECTIVE: To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem. CASE SUMMARY: A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (PT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization. DISCUSSION: The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk. CONCLUSIONS: Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.
Neu HC. Third generation cephalosporins: safety profiles after 10 years of clinical use.
J Clin Pharmacol. 1990 May;30(5):396-403. (Review)
Shirakawa H, Komai M, Kimura S. Antibiotic-induced vitamin K deficiency and the role of the presence of intestinal flora.
Int J Vitam Nutr Res. 1990;60(3):245-251.
Abstract: Cephalosporin antibiotics with N-methyl-thio-tetrazole (NMTT) side chains have been known to be associated with the development of hypoprothrombinemia. However, it has not been fully established whether these symptoms are induced by an inhibition of vitamin K production by intestinal microorganisms or by an inhibitory action of these antibiotics on endogenous vitamin K metabolism. Therefore, an attempt has been made to clarify the above-mentioned ambiguity by using germfree mice in which primary vitamin K deficiency can be established within a short experimental period. Germfree (GF) and conventional (CV) ICR male mice, 8-13 weeks old were used in this experiment. Vitamin K deficient (Def) and menaquinone-4 supplemented diet (MK-4) were fed to the mice in both rearing conditions. In the antibiotic-treated group, sodium latamoxef (LMOX, 300 mg/kg B.W./day) was intraperitoneally administered once a day, and in the control group the same volume of saline (Saline) was administered. Severe vitamin K deficient symptoms were observed in the GF-K-Def-LMOX group, and both prothrombin time (PT) and activated-partial thromboplastin time (APTT) values were prolonged on the 8th day of the experimental period compared with the GF-K-Def-Saline group. Furthermore the mortality rate of GF-K-Def-LMOX group was comparatively higher than that of the Saline group. This study has provided evidence that vitamin K deficiency is amplified by an administration of LMOX even in the absence of intestinal flora.
Tibbitts JS, Lipsky JJ. Effect of biliary diversion on the ability of cefamandole to inhibit vitamin K metabolism.
Drug Metabol Drug Interact. 1989;7(2-3):149-160.
Trenk D, Wagner F, Bechtold H, Nies B, Jahnchen E. Lack of effect of cefixime on the metabolism of vitamin K1.
J Clin Pharmacol 1990 Aug;30(8):737-742.
Abstract: It seems that cephalosporins bearing a N-methyl-thio-tetrazole or a methyl-thiadiazole moiety in their molecule can cause hypoprothombinemia in patients via inhibition of the metabolism of vitamin K1 if they are in addition in a vitamin K1-deficient state. The authors therefore studied the effects of two different oral doses (200 and 400 mg) of the cephalosporin cefixime on the metabolism of vitamin K1 in healthy volunteers, because the accumulation of vitamin K1-2,3-epoxide in plasma is a sensitive marker of coumarin-like activity of drugs. The results indicate that the development of hypoprothrombinemia due to an impairment of the metabolism of vitamin K1 by cefixime seems unlikely because only trace amounts of vitamin K1-2,3-epoxide could be determined in the plasma of the subjects investigated.
For more extensive citations relating to antibiotics and probiotics see the Footnotes subsection for the "Antibiotics" topic in this Interactions section.