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摘要
Hormonal contraception (HC) is used by millions of women worldwide to prevent unintended pregnancies. Because antibiotics are commonly used by reproductive-aged women, it is important to understand whether drug interactions between HC and antibiotics can contribute to HC failure or pose safety concerns.
Although rifamycin antibiotics induce hepatic enzymes that are required for HC metabolism, it cannot be assumed that other antibiotics act similarly. Because of common misconceptions regarding HC and drug interactions, a majority of pharmacists have recommended backup contraception for women using antibiotics with HC. If no true drug interaction is present, this recommendation could result in interruption of a woman's HC or poor compliancewith antibiotic regimens, increasing her risk of treatment failure with either drug. Older uncontrolled observational studies, case series, and guidelines based on case reports suggested that failures of HC in women who use antibiotics are due to drug interactions. However, more data are needed to demonstrate such interactions for nonrifamycin antibiotics.
The aim of this systematic review was to evaluate published articles that evaluated the interaction of nonrifamycin antibiotics and HC. Specific aims were to determine whether women taking HC or nonrifamycin antibiotics together experience decreased contraceptive or antibiotic effectiveness or increased hormonal or antibiotic toxicity compared with women taking each drug alone. A search of MEDLINE, EMBASE, Clinicaltrials. gov, and Cochrane databases was performed to identify relevant articles published in any language from inception through June 2016. Trials, cohort, case-control, and pharmacokinetic studies were included that addressed pregnancy rates, pharmacodynamics, or pharmacokinetic outcomes when any hormonal contraceptive and nonrifamycin antibiotic were administered together or alone. All included studies were required to have a comparison group. Study quality and risk of bias were independently assessed by 2 authors using the US Preventive Services Task Force evidence grading system. Data are presented for each drug class. Only studies addressing oral contraceptive pills, emergency contraception pills, and the combined vaginal ring were included.
The quality of studies ranged from good to poor. Two studies comparing pregnancy rates found no difference in women who used oral contraceptives with and without nonrifamycin antibiotics. No study combining hormonal contraceptives with any antibiotic observed differences in ovulation suppression or breakthrough bleeding. There were no significant decreases in any progestin pharmacokinetic parameter during coadministration with any antibiotic. The area under the curve for ethinyl estradiol decreased when administered with dirithromycin, but with no other antibiotic.
Evidence from this systematic review does not support drug interactions between hormonal contraceptives and nonrifamycin antibiotics. However, data are limited by the low quality and quantity of published evidence for some drug classes. No reduction in hormonal contraceptive effect with concurrent use of nonrifamycin antibiotics can be expected by most women.
- 出版日期2018-2
