The difficulties of polytherapy: examples from antimicrobial chemotherapy.


:Medical therapy in patients with more than one pathology means using more pharmaceuticals, which results in a higher risk of drug interactions which are modifications in the action of one drug when it is administered in the presence of another. The consequences can be diminished therapeutic effect or increased adverse reactions. The pharmacological interactions can be either physico-chemical, pharmacokinetic or pharmacodynamic, on the basis of their mechanisms. Pharmacokinetic interactions are the most important and can emerge during various phases of absorption, distribution, metabolism and drug elimination. The absorption of many antimicrobial agents can be modified through various mechanisms. Some drugs (for example the anticholinergics and opiates) or food can slow gastric motility, slowing the absorption and reducing maximum concentrations of the antibiotic. Variations in gastric pH can alter the solubility or chemical stability of molecules such as the beta-lactams, the natural macrolides and some azoles. The bioavailability of these drugs can be reduced due to molecules used to raise gastric pH. Antibiotics such as tetracycline or the fluoroquinolones have reduced bioavailability due to chelation from bi- and trivalent cations. The primary number of clinically relevant pharmacological interactions is correlated with modifications of biotransformation of drugs due to Cytochrome P450 (CYP) hepatic enzymes which are involved in oxidative drug processes, including lipophilic antimicrobial drugs such as the macrolides, the fluoroquinolones (to be considered amphoteric) and the antifungal azole derivatives. CYP3A is probably one of the most important isoenzymes since it contributes to at least the partial transformation of 60% of drugs that undergo oxidation: erythromycin and clarithromycin are CYP3A4 substrates. Many isoenzymes can also be inhibited by antimicrobial drugs, including both antibacterials and antifungals (for example the macrolides, fluoroquinolones, metronidazole, sulfonamides and azole derivatives) with a consequent reduction in the metabolism of other drugs, thus increasing their blood concentrations and possible correlated adverse reactions. On the other hand, rifampicin, rifabutin and some anticonvulsants can induce enzymatic metabolism, causing reduced blood concentrations and lower AUC of itraconazole and voriconazole with possibly lower therapeutic efficacy. This brief review of pharmacological interactions among certain chemotherapeutic agents leads us to believe that this problem is destined to occur with more frequency in daily clinical practice. What is needed is basic knowledge of drug interactions on the part of all physicians who work in the fields of clinical therapeutics with the goal of reducing the high number of medical errors.


Intern Emerg Med


Mazzei T




Has Abstract


2011-10-01 00:00:00








6 Suppl 1


  • Italian intersociety consensus on DOAC use in internal medicine.

    abstract::The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, a...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Prisco D,Ageno W,Becattini C,D'Angelo A,Davì G,De Cristofaro R,Dentali F,Di Minno G,Falanga A,Gussoni G,Masotti L,Palareti G,Pignatelli P,Santi RM,Santilli F,Silingardi M,Tufano A,Violi F,SIMI (Italian Society of Inte

    更新日期:2017-04-01 00:00:00

  • Physician in triage improves emergency department patient throughput.

    abstract::To determine if a physician in triage (PIT) improves Emergency Department (ED) patient flow in a community teaching hospital. This is an interventional study comparing patient flow parameters for the 3-month periods before and after implementation of a PIT model. During the interventional time an additional attending ...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Imperato J,Morris DS,Binder D,Fischer C,Patrick J,Sanchez LD,Setnik G

    更新日期:2012-10-01 00:00:00

  • A simple lung ultrasound protocol for the screening of COVID-19 pneumonia in the emergency department.

    abstract::The most relevant manifestation of coronavirus disease 2019 (COVID-19) is interstitial pneumonia. Several lung ultrasound (US) protocols for pneumonia diagnosis are used in clinical practice, but none has been proposed for COVID-19 patients' screening in the emergency department. We adopted a simplified 6-scan lung US...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Dacrema A,Silva M,Rovero L,Vertemati V,Losi G,Piepoli MF,Sacchi R,Mangiacotti M,Nazerian P,Pagani L,Tinelli V,Poggiali E,Bastoni D,Vercelli A,Magnacavallo A

    更新日期:2021-01-11 00:00:00

  • Variations in clinical management of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation according to different equations for estimating renal function : Post hoc analysis of a prospective cohort.

    abstract::Prescription of non-vitamin K antagonist oral anticoagulants (NOACs) requires an assessment of renal function (RF) and the Cockcroft-Gault (CG) equation is traditionally recommended. The objective of the study was to evaluate the potential changes in NOACs management using different equations for estimating RF. In a p...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Malavasi VL,Pettorelli D,Fantecchi E,Zoccali C,Laronga G,Trenti T,Lip GYH,Boriani G

    更新日期:2018-10-01 00:00:00

  • Amiodarone-related thyroid dysfunction.

    abstract::Nowadays, amiodarone is the most commonly used antidysrhythmic drug in clinical practice. It is highly effective in the management of recurrent ventricular dysrhythmias, paroxysmal supraventricular dysrhythmias, including atrial fibrillation and flutter, and in the maintenance of sinus rhythm after electrical cardiove...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Hudzik B,Zubelewicz-Szkodzinska B

    更新日期:2014-12-01 00:00:00

  • NIV by an interdisciplinary respiratory care team in severe respiratory failure in the emergency department limited to day time hours.

    abstract::Non-invasive ventilatory support is frequently used in patients with severe respiratory failure (SRF), but is often limited to intensive care units (ICU). We hypothesized that an instantaneous short course of NIV (up to 2 h), limited to regular working hours as an additional therapy on the emergency department (ED) wo...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Horvath CM,Brutsche MH,Schoch OD,Schillig B,Baty F,vonOw D,Rüdiger JJ

    更新日期:2017-12-01 00:00:00

  • Survival protection by bodyweight in isolated scleroderma-related pulmonary artery hypertension.

    abstract::In chronic heart failure (CHF) due to systemic cardiovascular disease, obese patients have better survival. Bodyweight versus survival was analyzed post hoc in subjects with limited scleroderma (SSc) and isolated pulmonary artery hypertension (PAH), i.e. with CHF due to pulmonary vascular disease. Rheumatologists refe...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Marini C,Formichi B,Bauleo C,Michelassi C,Airò E,Rossi G,Giuntini C

    更新日期:2016-10-01 00:00:00

  • Correction to: Reversal agents for oral anticoagulant-associated major or life-threatening bleeding.

    abstract::The article Reversal agents for oral anticoagulant-associated major or life-threatening bleeding, written by Marco Moia, Alessandro Squizzato was originally published electronically on the publisher's internet portal (currently SpringerLink) on 24 August 2019 without open access. ...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,已发布勘误


    authors: Moia M,Squizzato A

    更新日期:2020-06-01 00:00:00

  • Predictors of hospital readmission 1 year after ischemic stroke.

    abstract::Predictors of short-term readmission after ischemic stroke have been previously identified, but few studies analyzed predictors of long-term readmission, namely early imaging findings and treatment with intravenous thrombolysis (IVT). To characterize predictors of hospital readmission during the first year after hospi...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Leitão A,Brito A,Pinho J,Alves JN,Costa R,Amorim JM,Ribeiro M,Pinho I,Ferreira C

    更新日期:2017-02-01 00:00:00

  • Quality of life impairment in Behçet's disease and relationship with disease activity: a prospective study.

    abstract::Our aim was to prospectively investigate the impact of Behçet's disease (BD), disease activity, and clinical and demographic characteristics on different aspects of quality of life (QoL) measured by the short-form (SF)-36 QoL scale. We administered the SF-36 to 37 consecutive BD patients in different moments of diseas...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Fabiani C,Vitale A,Orlando I,Sota J,Capozzoli M,Franceschini R,Galeazzi M,Tosi GM,Frediani B,Cantarini L

    更新日期:2017-10-01 00:00:00

  • Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

    abstract::In non-ST-elevation acute coronary syndromes (ACS), an early invasive strategy is recommended for middle/high-risk patients; however, the optimal timing for coronary angiography is still debated. The aim of this study was to evaluate the prognostic implications of the time of angiography in ACS patients treated in acc...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Giglioli C,Cecchi E,Landi D,Valente S,Chiostri M,Romano SM,Spini V,Perrotta L,Simonetti I,Gensini GF

    更新日期:2013-03-01 00:00:00

  • Chronic kidney disease and kidney health care status: the healthy life in Suriname (HeliSur) study.

    abstract::The high cardiovascular risk burden in low- and middle-income countries is expected to lead to an explosive increase in chronic kidney disease (CKD). However, population data on CKD from these countries are scarce. Therefore, we assessed kidney health in Suriname. In the Healthy Life in Suriname (HeliSur) study, a ran...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Nannan Panday R,Haan Y,Diemer F,Punwasi A,Rommy C,Heerenveen I,van Montfrans GA,Brewster LM

    更新日期:2019-03-01 00:00:00

  • Right ventricular function predicts cardiovascular events in outpatients with stable cardiovascular diseases: preliminary results.

    abstract::Right ventricular (RV) function impacts the outcome in cardiac and pulmonary diseases such as heart failure, pulmonary hypertension, myocardial infarction, valvular, and congenital heart diseases. To our knowledge, simultaneous evaluation of left ventricular (LV) and RV systolic and diastolic echocardiographic indices...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Giovanardi P,Tincani E,Rossi R,Agnoletto V,Bondi M,Modena MG

    更新日期:2012-06-01 00:00:00

  • Acute kidney injury and vancomycin/piperacillin/tazobactam in adult patients: a systematic review.

    abstract::The aim of this systematic review was to assess AKI (acute kidney injury) in adult patients, treated with vancomycin (V) + piperacillin/tazobactam (PT) compared to V monotherapy. Studies were found in Pubmed, Web of Science and Scopus databases. Articles not in English, pediatric studies and case reports were excluded...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Ciarambino T,Giannico OV,Campanile A,Tirelli P,Para O,Signoriello G,Giordano M

    更新日期:2020-03-01 00:00:00

  • A narrative review of coronavirus disease 2019 (COVID-19): clinical, epidemiological characteristics, and systemic manifestations.

    abstract::Coronavirus disease 2019 (COVID-19) is an emerging infectious disease which has had a rapid surge in cases and deaths since it is first documented in Wuhan, China, in December 2019. COVID-19 is caused by the Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 uses angiotensin-conve...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Krishnan A,Hamilton JP,Alqahtani SA,A Woreta T

    更新日期:2021-01-16 00:00:00

  • Relation between admission serum potassium levels and long-term mortality in acute coronary syndrome.

    abstract::Serum potassium homeostasis play an important role in myocardial function, but the impact of serum potassium levels on long-term mortality has not been well evaluated. In the current study, we investigated patients with acute coronary syndrome (ACS) and analyzed the relationship between admission serum potassium level...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Peng Y,Huang FY,Liu W,Zhang C,Zhao ZG,Huang BT,Liao YB,Li Q,Chai H,Luo XL,Ren X,Chen C,Meng QT,Huang DJ,Wang H,Chen M

    更新日期:2015-12-01 00:00:00

  • An Italian version of the Ottawa Crisis Resource Management Global Rating Scale: a reliable and valid tool for assessment of simulation performance.

    abstract::Objective measurement of simulation performance requires a validated and reliable tool. However, no published Italian language assessment tool is available. Translation of a published English language tool, the Ottawa Crisis Resource Management Global Rating Scale (GRS), may lead to a validated and reliable tool. Afte...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Franc JM,Verde M,Gallardo AR,Carenzo L,Ingrassia PL

    更新日期:2017-08-01 00:00:00

  • Management of patients with chronic heart failure and type 2 diabetes mellitus: the SCODIAC-II study.

    abstract::SCODIAC was a pilot study which revealed an increasing use of SGLT2i in 123 outpatients affected with Heart Failure (HF) and Type 2 Diabetes Mellitus. SCODIAC-II study, the second phase of the program, has been carried out to determine diagnostic and therapeutic pathways in a larger group of patients and to verify whe...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: De Luca M,Bosso G,Valvano A,Guardasole V,Botta A,Carbone V,Carella G,Del Buono A,Di Giovanni G,Fimiani B,Guarnaccia F,Lapice E,Martedì E,Memoli G,Oliva D,Romano G,Cittadini A,Zito GB,Oliviero U

    更新日期:2020-10-17 00:00:00

  • A meta-analysis of randomized controlled trials: combination of ketamine and propofol versus ketamine alone for procedural sedation and analgesia in children.

    abstract::Although ketamine has been used for procedural sedation and analgesia, some researchers have assessed ketamine-propofol as a better alternative because of its reduced adverse events. The goal of this review was to compare adverse events between ketamine-propofol and ketamine for procedural sedation and analgesia in ch...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,meta分析


    authors: Hu Y,Xu W,Cao F

    更新日期:2019-10-01 00:00:00

  • Gut microbiota modulation: probiotics, antibiotics or fecal microbiota transplantation?

    abstract::Gut microbiota is known to have a relevant role in our health, and is also related to both gastrointestinal and extradigestive diseases. Therefore, restoring the alteration of gut microbiota represents an outstanding clinical target for the treatment of gut microbiota-related diseases. The modulation of gut microbiota...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Cammarota G,Ianiro G,Bibbò S,Gasbarrini A

    更新日期:2014-06-01 00:00:00

  • Pneumonia in frail older patients: an up to date.

    abstract::Despite advances in diagnosis, antimicrobial therapy and supportive care modalities, community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality, especially in patients who require hospitalization. Elderly patients with poor functional status are characterized by a higher risk of developin...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Falcone M,Blasi F,Menichetti F,Pea F,Violi F

    更新日期:2012-10-01 00:00:00

  • ESC position paper on cardiovascular toxicity of cancer treatments: challenges and expectations.

    abstract::The recent position paper of the European Society of Cardiology (ESC) on cardiovascular toxicity of cancer treatments has attracted considerable interest by healthcare professionals, since it is the first concrete help in the difficult task of monitoring and approaching cardiovascular side effects of anticancer treatm...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Raschi E,Diemberger I,Cosmi B,De Ponti F

    更新日期:2018-01-01 00:00:00

  • Endometriosis, need for a multidisciplinary clinical setting: the internist's point of view.

    abstract::Endometriosis is a common condition characterized by proliferation of endometrial tissue outside the uterus, both in the pelvis and in other extra-pelvic sites. The clinical picture of endometriosis is widely heterogeneous. A correct diagnostic work-up of these patients can sometimes be very difficult, since there are...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Montalto M,Santoro L,D'Onofrio F,Gallo A,Campo S,Campo V,Gasbarrini A,Gasbarrini G

    更新日期:2010-12-01 00:00:00

  • Emergencies in motoneuron disease.

    abstract::Genetic and acquired motor-neuron-disorders (MNDs) may undergo acute deterioration resulting in various emergency situations. This literature review aims at summarising and discussing current knowledge about emergencies in MNDs. Emergencies that have been reported in MND patients include: respiratory, bulbar, cardiac,...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Finsterer J,Stöllberger C

    更新日期:2017-08-01 00:00:00

  • Validation of the Italian version of a new coma scale: the FOUR score.

    abstract::The Glasgow Coma Scale (GCS) is the most widely accepted tool for the evaluation of consciousness, despite several reported shortcomings. A new coma scale, named Full Outline of UnResponsiveness (FOUR) score, is now available. The aim of the present study is to provide and validate the Italian version of the FOUR scor...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Marcati E,Ricci S,Casalena A,Toni D,Carolei A,Sacco S

    更新日期:2012-04-01 00:00:00

  • Cardiovascular oncology: a new discipline inside internal medicine?

    abstract::Cardiovascular disease and cancer incidence and prevalence have risen over the past few decades to become the leading causes of death. On the one hand, cancer patients will be treated with cardiotoxic chemotherapies; on the other, cardiovascular patients will receive a new diagnosis of cancer and will have to face tre...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Prisco D,D'Elios MM,Cenci C,Ciucciarelli L,Tamburini C

    更新日期:2014-06-01 00:00:00

  • Upper extremity deep vein thrombosis.

    abstract::Upper extremities deep venous thrombosis (UEDVT) is a rare condition. According to the literature, approximately 4-10% of all cases of venous thrombosis may involve the subclavian, axillary or brachial veins. In the last few decades, the incidence of UEDVT has increased because of more frequent use of central venous c...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章,评审


    authors: Spiezia L,Simioni P

    更新日期:2010-04-01 00:00:00

  • Hypoadiponectinemia, cardiometabolic comorbidities and left ventricular hypertrophy.

    abstract::This study was designed to evaluate the prevalence of cardiometabolic comorbidities and the changes in left ventricular geometry and function in 135 subjects subgrouped according to low or normal total adiponectin plasma (ADPN) levels. Left ventricular (LV) internal diameter/height, total LV mass (LVM) and LVM index (...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Di Chiara T,Argano C,Scaglione A,Duro G,Corrao S,Scaglione R,Licata G

    更新日期:2015-02-01 00:00:00

  • Drug-drug interactions in patients with acute coronary syndrome across phases of treatment.

    abstract::The objective of this study is to evaluate potential drug-drug interactions (pDDIs) and risk factors for pDDIs in three phases of an acute coronary syndrome (ACS) treatment: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization ...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Pejčić AV,Janković SM,Davidović G

    更新日期:2019-04-01 00:00:00

  • Thrombin generation in plasma from patients with cirrhosis supplemented with normal plasma: considerations on the efficacy of treatment with fresh-frozen plasma.

    abstract::Cirrhosis is characterized by a complex coagulation defect leading to the prolongation of the prothrombin and activated partial thromboplastin times (PT and APTT). Arbitrary PT cut-off values are still used as a yardstick to guide treatment with fresh-frozen plasma (FFP) or other pro-coagulant agents in patients under...

    journal_title:Internal and emergency medicine

    pub_type: 杂志文章


    authors: Tripodi A,Chantarangkul V,Primignani M,Clerici M,Dell'era A,Aghemo A,Mannucci PM

    更新日期:2012-04-01 00:00:00