Quinolones
Antibiotics/Nutrient Depletion:
Beta-caroteneBeta-carotene: According to secondary sources, oral neomycin sulfate may reduce beta-carotene absorption, but short-term use is unlikely to have an effect.
BiotinBiotin: According to secondary sources, broad-spectrum antibiotics such as sulfa drugs may alter the normal intestinal bacteria (flora) which make biotin. Although it is not clear if this flora-produced biotin may actually be used by humans, testing of biotin blood or urine levels should be considered in individuals using these drugs chronically. Biotin supplementation may be necessary if a deficiency is found.
CarnitineCarnitine: Clinical studies of S-1108 suggest cephalosporin may reduce plasma carnitine levels (1503438, 8517691). Based on human studies, cefditoren pivoxil may reduce carnitine due to an increase in urinary carnitine excretion and a decrease in free carnitine concentration (8254895). Based on a review, pivampicillin may reduce plasma and tissue carnitine content through an ester binding formation of pivalic acid (16752941). Based on human studies, pivampicillin may increase urinary excretion of pivaloylcarnitine through a partially reversible binding formation between carnitine and pivaloyl moiety (9365072, 8079264, 8257960, 1494519). According to a case report, sulfadiazine may induce carnitine deficiency (8328486).
CopperCopper: Based on in vitro evidence, ethambutol (Myambutol?) may chelate copper (7257959). Theoretically, copper chelation in the retina may contribute to ethambutol-induced optic neuropathy, but it is unclear whether supplemental copper may prevent this adverse effect.
FolateFolate: Based on secondary sources, antibiotic therapy, such as chloramphenicol and cycloserine, may disrupt the normal gastrointestinal (GI) flora, interfering with the absorption of folic acid. Aminosalicylic acid (para-aminosalicylic acid, PAS, Paser?) may reduce dietary folate absorption, worsening the folate deficiency often seen with active tuberculosis, or preventing its reversal during treatment.
IronIron: Based on secondary sources, aminosalicylic acid (para-aminosalicylic acid, PAS, Paser?) may cause a malabsorption syndrome, which includes iron and vitamin depletion. Based on a review, tetracycline derivatives may reduce the absorption of iron via chelation (946598).
MagnesiumMagnesium: According to secondary sources, nephrotoxicity caused by aminoglycosides (e.g., streptomycin and tobramycin) may lead to increased urinary loss of various electrolytes, including magnesium. There is conflicting evidence as to whether administration of oral magnesium salts with oral tetracyclines, quinolones, or other antibiotics may form non-absorbable complexes, resulting in decreased absorption of tetracyclines and quinolones (1969784, 9416381, 201941, 1981000, 2610502, 2610509, 10099040, 1354432, 1510420). According to human study, magnesium may reduce the effectiveness of fluoroquinolone antibiotics via chelation (16355977, 16632447).
NiacinNiacin: According to anecdotal evidence, antibiotics may lead to a decreased production of B vitamins through the destruction of normal gastrointestinal flora. Based on a case report, chloramphenicol may induce vitamin B3 deficiency due to a deficiency of nicotinamide or of its precursor tryptophan (9856171).
PotassiumPotassium: Based on case reports, potassium may be decreased due to reversible tubular damage in the kidney after prolonged aminoglycoside administration (12571406, 11005366, 9438655). Based on a review, aminoglycosides may affect toxic effects in the proximal tubule and collecting duct, which may lead to hypokalemia (19322184). According to case reports, high-dose intravenous ampicillin sodium may cause hypokalemic metabolic alkalosis (326044, 7687, 6529648, 4110324). Based on human study, broad spectrum penicillins such as piperacillin may reduce serum potassium (11967611). According to secondary sources, tetracyclines and their derivatives may decrease potassium level due to increased renal excretion.
ProbioticsProbiotics: Based on human study, antibiotics taken internally may destroy beneficial bacteria that normally assist in digestive and immune functions (452770).
Vitamin A/retinolVitamin A/retinol: Neomycin may interfere with the absorption of vitamin A (5020271), although the clinical significance of this interaction is currently unclear.
Vitamin B1/thiamineVitamin B1/thiamine: Based on in vitro studies, some antibiotics such as chloramphenicol, tetracycline, or fusidic acid may reduce the synthesis of thiamine (12533450). Some antibiotics may destroy gastrointestinal flora (normal bacteria in the gut) (452770) that manufacture some B vitamins. According to secondary sources, this may decrease the amount of thiamin available to humans, although the majority of thiamin may be obtained through the diet (not via bacterial production). This interaction is likely not clinically relevant, and secondary sources indicate that patients receiving antibiotics are generally not advised to take additional thiamin supplementation.
Vitamin B2/riboflavinVitamin B2/riboflavin: Based on human evidence, antibiotics may decrease riboflavin levels (3611907). According to secondary sources, riboflavin either alone or in combination with other B vitamins should be taken at different times from tetracycline. Secondary sources cite that oral administration of a variety of antibiotics may have little or no influence on urinary riboflavin excretion. A decrease in riboflavin excretion, however, may occur. Simultaneous intake of riboflavin and other B vitamins with tetracyclines may reduce absorption and bioavailability of agents due to the antibacterial effect on intestinal flora and gut ecology. It may be recommended to separate the concurrent administration of both.
Vitamin B5/pantothenic acidVitamin B5/pantothenic acid: Based on animal studies, treatment with antibiotics may elicit severe signs of pantothenic acid deficiency in mice, which may be due to a reduced panthotenic acid production by intestinal bacteria (2621490).
Vitamin B6/pyridoxineVitamin B6/pyridoxine: According to anecdotal reports, destruction of normal gastrointestinal flora by antibiotics may cause decreased production of B vitamins. Secondary sources also cite that cycloserine is an antibiotic that may cause anemia or peripheral neuritis by acting as a pyridoxine antagonist or increasing renal excretion of pyridoxine. Requirements for pyridoxine may be increased in patients receiving cycloserine. Secondary sources indicate that isoniazid (INH, Rifamate?) may increase pyridoxine requirements.
Vitamin B12Vitamin B12: According to secondary sources, long-term antibiotic use may deplete vitamin B12 levels. In people with bacterial overgrowth of the small bowel, antibiotics such as metronidazole (Flagyl?) may actually improve vitamin B12 status. Secondary sources also cite that aminosalicylic acid and neomycin may reduce oral vitamin B12 absorption, megaloblastic changes, and occasional cases of symptomatic anemia have occurred, usually after doses of eight to 12 grams per day for several months of aminosalicylic acid.Based on secondary sources, antibiotic therapy such as cephalosporins and tetracyclines may reduce dibencozide (active form of vitamin B12) levels due to decreased production by intestinal bacteria. According to secondary sources, neomycin may reduce dibencozide due to reduced absorption of dibencozide.
Vitamin C/ascorbic acidVitamin C/ascorbic acid: Based on secondary sources, the effects of vitamin C may be decreased by tetracycline antibiotics such as doxycycline (Vibramycin?), minocycline (Minocin?), or tetracycline (Sumycin?).
Vitamin D/calciferolVitamin D/calciferol: Based on human evidence, rifampin may induce osteomalacia (7314253, 7379450). The need for vitamin D supplementation with rifampin has not been thoroughly studied, although additional supplementation may be necessary.
Vitamin KVitamin K: According to secondary sources, some antibiotics may decrease the bacteria in the human gut (which synthesize a small amount of the human vitamin K requirement). Broad-spectrum antibiotics, particularly sulfonamides such as Bactrim?, may lower vitamin K levels and increase the risk of deficiency in people not ingesting adequate amounts of vitamin K (3598347, 17315736). Case reports of vitamin K deficiency in patients treated with rifampin and isoniazid suggests the possibility of vitamin K depletion with these drugs (12458578, 7661184).
ZincZinc: Based on a review, zinc may decrease absorption and serum levels of demeclocycline, minocycline, and tetracycline due to zinc binding (946598). According to a review, doxycycline may modulate zinc activity (12878048).