Drug Interactions between amoxicillin / clarithromycin / vonoprazan and typhoid vaccine, live

ADJUST DOSING INTERVAL: The use of live, attenuated oral typhoid vaccine with antibacterial sulfonamides or other antibiotics may result in a diminished immunologic response to the vaccine. Some antibiotics may be active against the vaccine strain of Salmonella typhi (Ty21a), thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response. Several antimalarial drugs such as chloroquine, mefloquine, and pyrimethamine-sulfadoxine also possess antibacterial activity, but concomitant administration did not significantly reduce immune response to the vaccine or compromise its efficacy in healthy adult study subjects. By contrast, concomitant administration of single agent proguanil did cause a significant decrease in the immune response rate, but the commercialized combination product atovaquone-proguanil did not have the same effect. The effects of other antimalarial agents have not been studied.

MANAGEMENT: Live, attenuated oral typhoid vaccine should not be administered during and for at least 3 days before and after treatment with antibacterial sulfonamides or other antibiotics. A longer interval should be considered following treatment with long-acting antibiotics (e.g., azithromycin). If malaria prophylaxis is needed, the same 3-day interval at the minimum should be observed between antimalarials and the vaccine. However, chloroquine, mefloquine, atovaquone-proguanil, and pyrimethamine-sulfadoxine may be given concomitantly with the vaccine. Alternatively, parenteral typhoid vaccine (typhoid Vi polysaccharide vaccine) may be considered if coadministration with antibacterial agents is required.

ADJUST DOSING INTERVAL: The use of live, attenuated oral typhoid vaccine with antibacterial sulfonamides or other antibiotics may result in a diminished immunologic response to the vaccine. Some antibiotics may be active against the vaccine strain of Salmonella typhi (Ty21a), thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response. Several antimalarial drugs such as chloroquine, mefloquine, and pyrimethamine-sulfadoxine also possess antibacterial activity, but concomitant administration did not significantly reduce immune response to the vaccine or compromise its efficacy in healthy adult study subjects. By contrast, concomitant administration of single agent proguanil did cause a significant decrease in the immune response rate, but the commercialized combination product atovaquone-proguanil did not have the same effect. The effects of other antimalarial agents have not been studied.

MANAGEMENT: Live, attenuated oral typhoid vaccine should not be administered during and for at least 3 days before and after treatment with antibacterial sulfonamides or other antibiotics. A longer interval should be considered following treatment with long-acting antibiotics (e.g., azithromycin). If malaria prophylaxis is needed, the same 3-day interval at the minimum should be observed between antimalarials and the vaccine. However, chloroquine, mefloquine, atovaquone-proguanil, and pyrimethamine-sulfadoxine may be given concomitantly with the vaccine. Alternatively, parenteral typhoid vaccine (typhoid Vi polysaccharide vaccine) may be considered if coadministration with antibacterial agents is required.

Although some in vitro data indicate synergism between macrolide antibiotics and penicillins, other in vitro data indicate antagonism. When these drugs are given together, neither has predictable therapeutic efficacy. Data are available for erythromycin, although theoretically this interaction could occur with any macrolide. Except for monitoring of the effectiveness of antibiotic therapy, no special precautions appear to be necessary.