Interaction: Vaccines & Antibiotics/Antivirals

• Antibiotics do not have an effect on the immune response to most vaccines.
• No commonly used antimicrobial drug will inactivate a live-virus vaccine.
• However, antiviral drugs may affect vaccine replication in some circumstances.

Influenza Vaccine

• Live attenuated influenza vaccine should not be administered until 48 hours after cessation of therapy using antiviral drugs active against influenza (amantadine, rimantadine, zanamivir, oseltamivir).

Varicella Containing Vaccines

• Antiviral drugs active against herpesviruses (acyclovir, famciclovir) should be discontinued 24 hours before admin­istration of a varicella-containing vaccine, if possible.

Oral Typhoid Vaccine

• Live attenuated vaccines should generally be avoided in immunocompromised travelers, including those who are taking immunomodulators, calcineurin inhibitors, cytotoxic agents, antimetabolites, and high-dose steroids
• Antimicrobial agents may be active against the vaccine strain in the oral typhoid vaccine and may prevent an adequate immune response to the vaccine.
• Therefore, oral typhoid vaccine should not be given to people taking antibacterial agents.
• Vaccination with oral typhoid vaccine should be delayed for >72 hours after the administration of any such agent.
• Parenteral typhoid vaccine may be a more appropriate choice for these people.
• Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis may be given concurrently with the oral typhoid vaccine.

Rabies Vaccine

• Concomitant use of chloroquine may reduce the antibody response to intradermal rabies vaccine administered for preexposure vaccination.
• The intramuscular route should be used for people taking chloroquine concurrently. (Currently, intradermal administration of rabies vaccine is not approved in the United States)

BCG vaccine 

• should not be administered to individuals receiving drugs with anti-tuberculous activity, including fluoroquinolones

Recommendations

• There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events. However, as a precaution, with moderate or severe acute illness, all vaccines should be delayed until the illness has improved.
• Mild illnesses (such as otitis media, upper respiratory infections, and diarrhea) are NOT contraindications to vaccination.
• Do not withhold vaccination if a person is taking antibiotics.

References:

1. http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/interactions-among-travel-vaccines-drugs
2.  General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices. (MMWR 2011;60 (No. RR-2):1-61).
3. http://www.phac-aspc.gc.ca/publicat/cig-gci/p02-02-eng.php