| Aminoglycoside antibiotics: Syner-gistic bactericidal effects against Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Cit-robacter, Enterobacter, Serratia, and Proteus mirabilis. However, drugs are physically and chem-ically incompatible; inactivated when mixed or given together. Dont give together. 
 Clavulanic acid, sulbactam, tazobactam: Syner-gistic bactericidal effects against certain beta-lactamase-producing bacteria. May be used together for this effect.
 
 Methotrexate: Large doses of penicillins may in-terfere with renal tubular secretion of methotrex-ate; delayed elimination and elevated serum lev-els of methotrexate. Monitor child for toxicity.
 
 Probenecid: Blocked tubular secretion of piper-acillin, raising serum levels of drug. Probenecid may be used for this purpose.
 
 Vecuronium: Prolonged neuromuscular block-ade. Monitor child closely.
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