Pharmacokinetic drug-drug interactions between calcineurin inhibitors and proliferation signal inhibitors with anti-microbial agents: Implications for therapeutic drug monitoring

Infections account for 15% to 20% of deaths in transplant recipients; thus, rapid and appropriate therapeutic intervention is required. However, many anti-microbial agents can interact significantly with a transplant recipient's immunosuppressive regimen, placing them at risk for a potential adverse drug reaction and prolonged hospitalization. This investigation highlights the pharmacokinetic drug-drug interactions between the calcineurin inhibitors and proliferation signal inhibitors with commonly used anti-microbial agents, specifically addressing mechanism, management, onset of action, magnitude of effect and strength of evidence for each interaction.