title: Ceftriaxone Potentiates Warfarin Activity Greater Than Other Antibiotics in the Treatment of Urinary Tract Infections.
abstract: BACKGROUND
  The cephalosporin class has been associated with an increased risk of bleeding among elderly patients receiving warfarin. Urinary tract infections (UTI) are the most prevalent infection in elderly patients.
  
  
  OBJECTIVE
  To determine the extent of interaction between antibiotics used in the treatment of UTI, particularly specific cephalosporins and warfarin.
  
  
  METHODS
  A retrospective chart review was conducted on chronic warfarin patients with a diagnosis of UTI treated with ceftriaxone, a first-generation cephalosporin, penicillin, or ciprofloxacin. The primary outcome was the comparison of the extent of international normalized ratio (INR) change from baseline between each antibiotic group.
  
  
  RESULTS
  The ceftriaxone group was found to have a statistically significant higher peak INR value compared to all other studied antibiotics (ceftriaxone: 3.56, first-generation cephalosporins: 2.66, penicillins: 2.98, ciprofloxacin: 2.3; P = .004), a statistically significant greater extent of change in INR value (+1.19, +0.66, +0.8, +0.275; P = .006), and a statistically significant greater percentage change in INR value when compared to ciprofloxacin (54.4% vs 12.7%; P = .037).
  
  
  CONCLUSIONS
  Ceftriaxone interacts with warfarin to increase a patient's INR value more than other commonly administered antibiotics for UTI treatment. Other antibiotics should be preferred for UTI treatment in patients on warfarin.
authors.affiliation: Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Department of Pharmacy, St Vincent Hospital, Indianapolis, IN, USA lsaum@butler.edu.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Saum
authors.affiliation: Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Balmat
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002443:Ceftriaxone / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects; D002939:Ciprofloxacin / Q000009:adverse effects; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D019934:International Normalized Ratio; D010406:Penicillins / Q000009:adverse effects; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000097:blood / Q000188:drug therapy; D014859:Warfarin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D002939:Ciprofloxacin; D014859:Warfarin; D002443:Ceftriaxone
keywords: antibiotics; ceftriaxone; cephalosporins; interaction; warfarin