warfarin and Bacterial-Infections

Which antibiotics should you consider when a patient is taking warfarin? Which ones are associated with drug-induced, prolonged QT intervals? Read on.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Bacterial Infections; Blood Coagulation Disorders; Drug Interactions; Female; Hemorrhage; Humans; Male; Middle Aged; Warfarin

The elderly population is increasing worldwide and shows an increasing prevalence of frailty. Frailty is recognized as an important factor for inappropriate drug prescribing in elderly patients. Appropriate drug prescription, either in terms of drug choice or in terms of drug dosage, is of paramount importance among the frail elderly patients, this requiring the need of a difficult balance between efficacy, safety and tolerability. Bacterial infections are quite frequent among the elderly, and use of antimicrobials may be associated with severe adverse events in this population, especially when in presence of co-medications and/or of co-morbidities. The aim of this paper is to argue about the most recent published evidences on how to prevent major adverse events whenever antimicrobials should be co-prescribed in frail elderly patients.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Drug Interactions; Frail Elderly; Hemorrhage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypoglycemia; Hypoglycemic Agents; Kidney; Macrolides; Rhabdomyolysis; Treatment Outcome; Warfarin

Topics: Acute Disease; Aspirin; Bacterial Infections; Female; Heparin; Humans; Ovary; Phlebography; Plethysmography, Impedance; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Embolism; Renal Veins; Thromboembolism; Thrombophlebitis; Ultrasonography; Vena Cava, Inferior; Warfarin

The difference in type of antibiotics and susceptibility of. This study aimed to investigate association the between the prothrombin time-international normalized ratio (PT-INR) and concomitant use of antibiotics in a real-world population of warfarin users.. This was a single-center cohort study using data from health records and included patients who received β-lactams (BLs)/fluoroquinolones (FQs) during ongoing warfarin treatment (2011-2015) at Hamamatsu University Hospital in Japan. Antibiotics were categorized into those to which. A total of 1185 warfarin users were included. The proportion of INR ratio >2.5 in FQ. Concomitant use of FQs, or of antibiotics to which

Topics: Aged; Anti-Bacterial Agents; Anticoagulants; Bacterial Infections; Bacteroides fragilis; beta-Lactams; Blood Coagulation; Cohort Studies; Drug Interactions; Female; Fluoroquinolones; Hemorrhage; Humans; International Normalized Ratio; Longitudinal Studies; Male; Middle Aged; Prothrombin Time; Warfarin

To report a case in which the anticoagulant effects of warfarin were attenuated during concomitant administration of rifaximin, possibly through induction of CYP3A4 following increased absorption of rifaximin in a patient with small intestine bacterial overgrowth (SIBO).. A 49-year-old African American female had received effective anticoagulant therapy for 5 months with a target international normalized ratio (INR) of 2.0-3.5 on a warfarin regimen of 7.5 mg daily. Five days following initiation of rifaximin 400 mg 3 times daily to treat SIBO, her INR had fallen to 1.2 and remained suppressed throughout the duration of her rifaximin regimen despite incremental warfarin dosage increases (highest dose, 15 mg/day for 2 days, followed by 11.25 mg/day). Twelve days after completion of the rifaximin treatment course, the INR was supratherapeutic at 4.2, requiring titration to her baseline warfarin dosage to achieve an INR within the target range. Similar results were obtained following rechallenge with rifaximin.. Rifaximin has been shown in vitro to induce the CYP3A4 enzyme for which the R-isomer of warfarin is a known substrate. The lack of in vivo CYP3A4 induction with rifaximin in other patient populations has repeatedly been attributed to its minimal oral bioavailability, while a recent study found that patients with SIBO had a clinically significant increase in intestinal permeability. In this patient population it is plausible that rifaximin bioavailability increases enough to induce CYP3A4, leading to clinically significant reductions in the bioavailability of CYP3A4 substrates, including R-warfarin. An objective causality assessment of this case revealed that a warfarin-rifaximin interaction was probable. No other drug dosages were altered during the timeframe in question, and the patient had an impeccable medication adherence history; we therefore ruled out these potential etiologies.. To our knowledge, an interaction between warfarin and rifaximin has not been previously reported. While further research needs to be conducted to confirm these results, practitioners should be aware of this possibility because of the increasing use of rifaximin as a first-line choice in the treatment of SIBO.

Topics: Anticoagulants; Bacterial Infections; Cytochrome P-450 CYP3A; Drug Interactions; Drug Therapy, Combination; Enzyme Induction; Female; Gastrointestinal Agents; Humans; Intestine, Small; Middle Aged; Rifamycins; Rifaximin; Warfarin

A patient with Crohn's disease who required placement of a right external jugular vein central catheter for total hyperalimentation is presented. Catheter-induced thrombosis and catheter-associated bacteremia and sepsis subsequently developed. Following the description of the case is a brief discussion of the complications inherent in central line placement, the mechanisms by which thrombosis and sepsis occur, and the measures that can be taken to decrease the incidence of thrombosis and sepsis in central line placement. The management of central venous thrombosis and sepsis is medical and not surgical in nature, and consists of catheter removal, antibiotics, and anticoagulation.

Topics: Anti-Bacterial Agents; Bacterial Infections; Catheterization; Crohn Disease; Female; Heparin; Humans; Middle Aged; Parenteral Nutrition, Total; Thrombophlebitis; Warfarin

Anticoagulation is the cornerstone in the treatment of deep vein thrombosis. However, the treatment of septic deep vein thrombosis is controversial. Unlike septic superficial vein thrombosis, venous excision is often associated with limb-threatening or even life-threatening complications. Some authors have suggested thrombectomy as the only means of resolving the sepsis. We reviewed our experience with seven patients who had septic deep vein thrombosis. Phlebography or noninvasive studies documented deep vein thrombosis and blood cultures were positive in all patients. The mean age was 31.5 years with a male/female ratio of 5:2. All patients were treated with anticoagulants and intravenous antibiotics. One patient required surgical exploration for associated abscess of the groin. The patients became afebrile with normal white blood cell counts from 3 to 18 days after therapy was begun. No cases of recurrent sepsis occurred. We conclude that antibiotic therapy and anticoagulation are adequate treatment and therefore consider venous thrombectomy unnecessary.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Bacterial Infections; Drug Therapy, Combination; Female; Heparin; Humans; Male; Thrombophlebitis; Warfarin

Bacterial adherence as a result of specific surface properties may be a contributory factor in the pathogenesis of bacterial endocarditis giving certain types of bacteria a selective advantage to cause this disease. Adherence could interact with other pathogenetic mechanisms, and this interaction could promote or hamper the development of endocarditis. Dextran production by streptococci, the activation of the clotting system by monocyte tissue thromboplastin, and phagocytic removal of bacteria from the vegetational surface by granulocytes and monocytes are examples of interacting mechanisms that could contribute to the pathogenesis of bacterial endocarditis.

Topics: Adhesiveness; Animals; Aortic Valve; Bacterial Infections; Bacterial Physiological Phenomena; Dogs; Endocarditis, Bacterial; Etoposide; Fibrin; Humans; In Vitro Techniques; Mechlorethamine; Rabbits; Staphylococcus; Streptococcus; Virulence; Warfarin

The half-lives of warfarin and trimethoprim were significantly longer in mice acutely infected with Bacillus piloformis and in mice which ad clinically recovered from previous experimental infection with the organism. The volume of distribution of trimethoprim but not of warfarin was significantly greater in infected mice than in controls. Body clearances of warfarin was significantly reduced in both disease states. For trimethoprim this parameter was only reduced in the acute state of the disease. The importance of careful control of Tyzzer's disease in laboratory animals for use in pharmacological research is stressed.

Topics: Animals; Bacillus; Bacterial Infections; Liver; Male; Mice; Rodent Diseases; Trimethoprim; Warfarin

Topics: Anti-Bacterial Agents; Aortic Valve; Aspergillosis; Bacterial Infections; Calcinosis; Diagnosis, Differential; Embolism; Endocarditis; Furosemide; Heart Auscultation; Heart Valve Prosthesis; Heparin; Humans; Kidney; Lanatosides; Leg; Male; Middle Aged; Morphine; Myocardial Infarction; Myocardium; Oxygen; Postoperative Complications; Renal Artery; Thrombosis; Tooth Extraction; Warfarin