Drug Interactions between fecal microbiota spores, 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: Antibiotics may interfere with the therapeutic effects of oral fecal microbiota, which contains live bacterial spores. The mechanism may be related to the antibiotic inactivating the bacterial spores or reducing bacterial replication. However, the clinical significance of this interaction has not been established.

MANAGEMENT: Concomitant use of oral fecal microbiota spores with antibiotics should generally be avoided. The manufacturer of the oral formulation of fecal microbiota recommends that treatment commence two to four days after completing antibiotic treatment for Clostridium difficile infection.