Background Managing drug–food interactions may help to achieve the optimal action and safety profile of β-lactam antibiotics. Methods We conducted a systematic review with meta-analyses in adherence to PRISMA guidelines for 32 β-lactams. We included 166 studies assessing the impact of food, beverages, antacids or mineral supplements on the pharmacokinetic (PK) parameters or PK/pharmacodynamic (PK/PD) indices. Results Eighteen of 25 β-lactams for which data on food impact were available had clinically important interactions. We observed the highest negative influence of food (AUC or Cmax decreased by >40%) for ampicillin, cefaclor (immediate-release formulations), cefroxadine, cefradine, cloxacillin, oxacillin, penicillin V (liquid formulations and tablets) and sultamicillin, whereas the highest positive influence (AUC or Cmax increased by >45%) for cefditoren pivoxil, cefuroxime and tebipenem pivoxil (extended-release tablets). Significantly lower bioavailability in the presence of antacids or mineral supplements occurred for 4 of 13 analysed β-lactams, with the highest negative impact for cefdinir (with iron salts) and moderate for cefpodoxime proxetil (with antacids). Data on beverage impact were limited to 11 antibiotics. With milk, the extent of absorption was decreased by >40% for cefalexin, cefradine, penicillin G and penicillin V, whereas it was moderately increased for cefuroxime. No significant interaction occurred with cranberry juice for two tested drugs (amoxicillin and cefaclor). Conclusions Factors such as physicochemical features of antibiotics, drug formulation, type of intervention, and patient’s health state may influence interactions. Due to the poor actuality and diverse methodology of included studies and unproportionate data availability for individual drugs, we judged the quality of evidence as low.

中文翻译：

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饮食干预是否对 β-内酰胺抗生素的生物利用度产生临床上重要的影响？荟萃分析的系统评价

背景 管理药物与食物的相互作用可能有助于实现 β-内酰胺抗生素的最佳作用和安全性。方法 我们按照 PRISMA 指南对 32 种 β-内酰胺进行了系统评价和荟萃分析。我们纳入了 166 项研究，评估食品、饮料、抗酸剂或矿物质补充剂对药代动力学 (PK) 参数或 PK/药效 (PK/PD) 指数的影响。结果 25 种 β-内酰胺中，有 18 种具有食物影响数据，具有临床上重要的相互作用。我们观察到食物对氨苄西林、头孢克洛（速释制剂）、头孢罗沙定、头孢拉定、氯唑西林、苯唑西林、青霉素 V（液体制剂和片剂）和舒他西林的负面影响最大（AUC 或 Cmax 降低 > 40%），而头孢托仑匹酯、头孢呋辛和替比培南匹酯（缓释片）的积极影响最高（AUC或Cmax增加>45%）。在存在抗酸剂或矿物质补充剂的情况下，13 种分析的 β-内酰胺中有 4 种的生物利用度显着降低，头孢地尼（含铁盐）的负面影响最大，头孢泊肟酯（含抗酸剂）的负面影响中等。有关饮料影响的数据仅限于 11 种抗生素。对于牛奶，头孢氨苄、头孢拉定、青霉素G和青霉素V的吸收程度降低＞40％，而头孢呋辛的吸收程度适度增加。蔓越莓汁对两种测试药物（阿莫西林和头孢克洛）没有发生显着的相互作用。结论 抗生素的理化特征、药物配方、干预类型和患者健康状况等因素可能会影响相互作用。由于纳入研究的现实性较差、方法多样，而且个别药物的数据可用性不成比例，我们认为证据质量较低。