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The impact of anti-infective therapy on patients undergoing warfarin treatment

Linlin Fu1, Huimin Yao2, Wei Xu2

  • 1Department of Pharmacy, Nanjing Drum Tower Hospital, Basic Medicine and Clinical Pharmacy College, China Pharmaceutical University, Nanjing 210008, China.

Journal of Infection in Developing Countries
|January 20, 2025
PubMed
Abstract

Insights

Certain antibiotics significantly increase warfarin's effect, raising international normalized ratio (INR) values. Quinolones, sulfonamides, and antifungals most notably impact INR when combined with warfarin.

Area of Science:

  • Pharmacology
  • Internal Medicine
  • Infectious Diseases

Background:

  • Warfarin and antibiotic co-administration is common in clinical settings.
  • The precise impact of various antibiotics on warfarin's anticoagulant efficacy remains unclear.
  • This uncertainty complicates clinical decision-making for patients on both medications.

Purpose of the Study:

  • To investigate how different classes of antibiotics affect the international normalized ratio (INR) in patients receiving warfarin.
  • To identify specific antibiotic types that cause significant alterations in INR values.

Main Methods:

  • A retrospective cohort study was conducted involving 623 hospitalized patients.
  • Patients received concurrent warfarin and antibiotic therapy between 2013 and 2022.
  • Patients were grouped by antibiotic type (8 categories), and changes in INR were analyzed.

Main Results:

  • Antibiotic use generally elevated INR values in warfarin patients.
  • Quinolones, sulfonamides, and antifungal agents showed the most significant INR elevations.
  • Beta-lactams, glycopeptides, oxazolidinones, macrolides, and carbapenems had a less pronounced effect on INR.

Conclusions:

  • Co-administering warfarin with antibiotics leads to increased INR values.
  • Quinolones, sulfonamides, and antifungal agents are associated with the greatest INR elevations.
  • Awareness of these interactions is crucial for safe warfarin management.
Keywords:
INRantibioticsinteractionovercoagulationwarfarin

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