Drug Interaction Report

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.

ADJUST DOSING INTERVAL: Food may reduce the oral absorption and bioavailability of levofloxacin. According to the drug product labeling, administration of levofloxacin 500 mg with food prolonged the time to peak concentration by 1 hour and decreased the Cmax decreased by 25% following administration of the oral solution and by 14% following administration of the oral tablet.

MANAGEMENT: To ensure maximal and consistent oral absorption, levofloxacin oral solution should be taken at least one hour before or two hours after meals. For administration of the oral solution with continuous enteral nutrition, some experts recommend that the tube feeding should be interrupted for one hour before and two hours after the dose of levofloxacin. The oral tablets may be taken without regard to food.

ADJUST DOSING INTERVAL: There are no data regarding the effects of concurrent administration of oral fecal microbiota spores with food.

MANAGEMENT: The manufacturer of the oral formulation of fecal microbiota recommends that patients should have no food or drink except for a small amount of water for at least 8 hours prior to the first dose of fecal microbiota spores. The second and third doses of fecal microbiota spores should be taken on an empty stomach prior to the first meal of the day.