Drug Interaction Report

ADJUST DOSING INTERVAL: Coadministration of oral probiotic preparations with oral antibiotics may reduce the efficacy of the probiotic. It has been theorized that concomitant antibiotics may kill the live organisms found in lactobacillus-, bacillus coagulans-, and bifidobacteria-containing oral probiotic preparations. However, the clinical significance of the interaction has not been established.

MANAGEMENT: Although data are limited, it may be prudent to advise patients to take oral probiotics at least 1 to 2 hours before or after an oral antibiotic.

ADJUST DOSING INTERVAL: Coadministration of oral probiotic preparations with oral antibiotics may reduce the efficacy of the probiotic. It has been theorized that concomitant antibiotics may kill the live organisms found in lactobacillus-, bacillus coagulans-, and bifidobacteria-containing oral probiotic preparations. However, the clinical significance of the interaction has not been established.

MANAGEMENT: Although data are limited, it may be prudent to advise patients to take oral probiotics at least 1 to 2 hours before or after an oral antibiotic.

Concurrent ingestion of calcium-fortified foods (i.e., cereal, orange juice) may alter the bioavailability of gatifloxacin. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved. Data have been conflicting: One study has reported no effect with milk coadministration. Another study reported a modest decrease in gatifloxacin bioavailability (13.5% decrease in Cmax,12% decrease in AUC, 15% increase in total clearance) when taken with 12 ounces of calcium-fortified orange juice instead of water, which could be clinically significant if the infecting organisms have borderline susceptibilities. The manufacturer states that gatifloxacin may be taken without regard to food, milk, or calcium. Clinicians should be aware of the possibility of an interaction if subtherapeutic effects are observed.