{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:40:24Z","timestamp":1781264424236,"version":"3.54.1"},"reference-count":9,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health","award":["RC 34\/18"],"award-info":[{"award-number":["RC 34\/18"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Immunosuppression management in transplant recipients is a critical component of pharmacotherapy. This becomes particularly crucial when patients are exposed to multiple medications that may lead to pharmacological interactions, potentially compromising the effectiveness of immunosuppression. We present the case of a 46-year-old patient diagnosed with cystic fibrosis in childhood at our hospital, who underwent bilateral lung transplantation and is undergoing immunosuppressive therapy. The patient was hospitalized due to an acute pulmonary exacerbation. During the hospitalization, the patient was administered various classes of antibiotics while continuing the standard antirejection regimen of everolimus and mycophenolate. Plasma concentrations of immunosuppressants, measured after antibiotic therapy, revealed significantly lower levels than the therapeutic thresholds, providing the basis for formulating the hypothesis of a drug\u2013drug interaction phenomenon. This hypothesis is supported by the rationale of antibiotic-induced disruption of the intestinal flora, which directly affects the kinetics of mycophenolate. These levels increased after discontinuation of the antimicrobials. Patients with CF undergoing lung transplantation, especially prone to pulmonary infections due to their medical condition, considering the enterohepatic circulation of mycophenolate mediated by intestinal bacteria, necessitate routine monitoring of mycophenolate concentrations during and immediately following the cessation of antibiotic therapies, that could potentially result in insufficient immunosuppression.<\/jats:p>","DOI":"10.3390\/ijms25042358","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T05:39:56Z","timestamp":1708321196000},"page":"2358","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decrease in Mycophenolate Mofetil Plasma Concentration in the Presence of Antibiotics: A Case Report in a Cystic Fibrosis Patient with Lung Transplant"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3799-8718","authenticated-orcid":false,"given":"Giuliano","family":"Ponis","sequence":"first","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9714-6246","authenticated-orcid":false,"given":"Giuliana","family":"Decorti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6343-846X","authenticated-orcid":false,"given":"Egidio","family":"Barbi","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0964-5879","authenticated-orcid":false,"given":"Gabriele","family":"Stocco","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"},{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Maschio","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health, IRCCS \u201cBurlo Garofolo\u201d, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1056\/NEJMra2216474","article-title":"Cystic Fibrosis","volume":"389","author":"Grasemann","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.healun.2019.08.001","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match","volume":"38","author":"Chambers","year":"2019","journal-title":"J. Heart Lung Transpl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.healun.2022.08.007","article-title":"The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-ninth adult lung transplantation report-2022; focus on lung transplant recipients with chronic obstructive pulmonary disease","volume":"41","author":"Perch","year":"2022","journal-title":"J. Heart Lung Transpl."},{"key":"ref_4","unstructured":"International Society for Heart and Lung Transplantation Registry (2020, June 28). Adult Lung Transplantation Statistics. Available online: http:\/\/www.ishlt.org\/registries\/slides.asp?slides=heartLungRegistry."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2165\/00003088-200746010-00002","article-title":"Clinical pharmacokinetics and pharmacodynamics of mycophenolate in solid organ transplant recipients","volume":"46","author":"Staatz","year":"2007","journal-title":"Clin. Pharmacokinet."},{"key":"ref_6","first-page":"120","article-title":"Abbreviated mycophenolic acid AUC from C0, C1, C2, and C4 is preferable in children after renal transplantation on mycophenolate mofetil and tacrolimus therapy","volume":"17","author":"Filler","year":"2004","journal-title":"Transpl. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"372.e1","DOI":"10.1016\/j.jtct.2022.04.018","article-title":"Reduced Enterohepatic Recirculation of Mycophenolate and Lower Blood Concentrations Are Associated with the Stool Bacterial Microbiome after Hematopoietic Cell Transplantation","volume":"28","author":"Saqr","year":"2022","journal-title":"Transpl. Cell Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5005\/jp-journals-10071-23439","article-title":"Drug Interactions between Antimicrobial and Immunosuppressive Agents in Solid Organ Transplant Recipients","volume":"25","author":"Bhagat","year":"2021","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_9","unstructured":"The Italian Data Protection Authority (2023, July 06). Authorisation No. 9\/2014\u2014General Authorisation to Process Personal Data for Scientific Research Purposes. Available online: https:\/\/www.garanteprivacy.it\/web\/guest\/home\/docweb\/-\/docweb-display\/docweb\/3786078."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/4\/2358\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:01:02Z","timestamp":1760104862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/25\/4\/2358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,17]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["ijms25042358"],"URL":"https:\/\/doi.org\/10.3390\/ijms25042358","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,17]]}}}