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Pyrantel combantrin or mebendazole pinworm medication) and an antifungal (e.g., piroxicam or amphotericin B. A more detailed description of comprehensive antifungal regimen for tetracycline resistant infections may appear elsewhere.28–33 Drug Interactions for Tetracyclines and Toxins Drugs that reduce the activity of certain proteases (such as penicillin, rifampin, fluoroquinolones, and clindamycin) can be useful in improving resistance management.34 Some infections are associated with interactions rifampin, because rifampin induces the cysteine protease, as well other enzymes that are critical for the metabolism of certain drugs in the host. For this reason, it is important that patients on multiple drugs be monitored for interactions. Drug-Drug Interaction Drugs that inhibit drug-metabolizing systems can cause metabolic disorders that lead to increased susceptibility other drugs and even death. For example, the enzyme CYP3A4 is inhibited by the antibiotic metronidazole.35 This can block the metabolism of clindamycin, which inhibits CYP3A4 and the metabolism of other drugs that inhibit CYP3A4 (e.g., metronidazole, rifampin). The effect of metronidazole also affects how the human immune system responds to the drug when it is used in conjunction with clindamycin.36 Clindamycin has a high affinity for C3-hydroxylase (an enzyme that converts clindamycin to its active metabolite), which means that the compound has a much stronger effect at the lowest concentration that clindamycin reaches.37,38 These interactions can lead to significant metabolic disturbances for several days following antibiotic treatment. Drugs that inhibit other enzymes also increase susceptibility to other medications. The enzyme CYP2D6 is an important regulator of drug metabolism, and drug-drug interactions with this enzyme can result in significant drug toxicity. These interactions occur when a drug inhibits CYP2D6 and its metabolite. Drug-drug interaction reports are available for over 100 drug classes and approximately 10% of the reports are related to CYP2D6.39 Many of these interactions are minor, but potentially significant, concern as clinically significant or dangerous complications (e.g., cardiovascular and other complications), as well drug toxicities (e.g., blood dyscrasia, liver transplant rejection).40 In addition, this drug interaction pathway can also affect other drugs, some of which have very different chemical structures and may interact with drugs in the CYP2D6 system differently. most common type of drug-drug interaction, the CYP2D6 inhibitory/inhibiting (ICI) reaction, results in a drug-drug interaction, which is the most important mechanism of a drug-drug interaction, but is not limited to this mechanism. There will be drug-drug interactions with a broad range of drugs. In general, the more a drug can regulate metabolism, the more drug will affect that drug. Drug interactions involving antibiotics will be addressed in separate section. Drug–Antibiotic Interaction Infections requiring more intensive therapy, such as those involving multiple drugs or a wide array of pathogens (e.g., tuberculosis), may require the use of multiple antibiotics. Several drugs in a patient's treatment regimen are likely to interact with each other as well antibiotics.41 The risk of drug–antibiotic interactions with many antibiotics depends on the host and use of individual antibiotics.42–45 Many patients can benefit from taking a combination of medications that Xalatan 4mg $395.37 - $1.1 Per pill are not likely to inhibit other drugs.46 The majority of drug interactions that are observed in clinical settings due to the interaction of a drug with an antibiotic that is taken together. For example, the interaction caused by combination of cidofovir and rifampicin is associated with severe gastrointestinal bleeding,47 whereas the interaction involving use of tetracyclines and amphotericin B decreases susceptibility to the drug.46 Drug-Drug Interaction for Antibiotics Drug-drug interactions can also occur for drugs that inhibit drug systems as well drugs that alter the host's physiology. Many antibiotic drugs inhibit the human protease-phosphatase enzyme system (CYP3A). The CYP3A4 inhibitors, azithromycin and doxycycline, as well the drug daptomycin, decrease CYP3A4 activity through their inhibition of both the cysteine amino acid phosphatase gene and the cysteine protein phosphatase gene.47 Daptomycin inhibits the CYP3A4 system, and a drug of the azithromycin class (tetracycline) reduces CYP3A4 enzyme activity.

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