Antibiotic therapy under polypragmatic conditions: a course to safety

Prescribing safe and effective drug therapy is becoming increasingly challenging. Recently, there has been an upward trend in the number of patients experiencing polypragmasy. Thus, according to epidemiological analysis of 180,815 outpatient records in Scotland, 4–9 medications were simultaneously prescribed in 16.9% of cases, 10 or more drugs – in 4.6% of cases. As the number of medications taken by an individual patient increases, so does the likelihood of drug-drug interactions which have clinically important consequences. The number of drug-drug interactions is increasing as new drugs are approved, different metabolic pathways and drug transporters are discovered, and co-prescribing recommendations emerge. This article provides an overview of principles and mechanisms of drug-drug interactions and describes pharmacokinetic and pharmacodynamic interactions associated with antibiotic therapy.