Drug Interactions between cholera vaccine, live and moxifloxacin / triamcinolone

MONITOR CLOSELY: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism is unknown. Tendinitis and tendon rupture have most frequently involved the Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resulted in prolonged disability. Tendon rupture can occur during or up to several months after completion of fluoroquinolone therapy.

MANAGEMENT: Caution is recommended if fluoroquinolones are prescribed in combination with corticosteroids, particularly in patients with other concomitant risk factors (e.g., age over 60 years; recipient of kidney, heart, and/or lung transplant). Patients should be advised to stop taking the fluoroquinolone, avoid exercise and use of the affected area, and promptly contact their physician if they experience pain, swelling, or inflammation of a tendon. In general, fluoroquinolones should only be used to treat conditions that are proven or strongly suspected to be caused by bacteria and only if the benefits outweigh the risks.

GENERALLY AVOID: The safety and efficacy of live, attenuated cholera vaccine have not been established in patients receiving immunosuppressive therapies, including alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents, and long-term topical or inhaled corticosteroids. It is not known whether immunosuppressed patients may have an increased risk of adverse reactions or a decreased or suboptimal immunologic response to the vaccine.

MANAGEMENT: The safety and efficacy of live, attenuated cholera vaccine have not been established in patients receiving immunosuppressive therapies. Some authorities consider coadministration of live, attenuated oral cholera vaccine with immunosuppressant therapies contraindicated. Administration of live attenuated vaccines in severely immunocompromised persons is generally considered a contraindication. The risks of adverse reactions or a decreased or suboptimal immunologic response should be weighed against the benefits of vaccination. Current local immunization guidelines and individual product labeling for the prescribed immunosuppressive therapy should be consulted for further information.

ADJUST DOSING INTERVAL: The use of live, attenuated cholera vaccine with systemic antibiotics may result in a diminished immunologic response to the vaccine. Some antibiotics may be active against the vaccine strain of Vibrio cholerae, thereby preventing a sufficient degree of multiplication to occur in order to induce a protective immune response.

MANAGEMENT: It is recommended to avoid treatment with systemic antibiotics for 10 days after vaccination with live, attenuated cholera vaccine. In addition, vaccination with live, attenuated cholera vaccine should be avoided within 14 days of treatment with systemic antibiotics.