Flu Vaccine With On Table With Syringe

Answer

Hello and thank you for taking the time to reach out to us!

Whether or not a particular vaccine contains antibiotics is a common question we get. In fact, not too long ago, we answered a similar question about the shingles vaccine (for the record, Shingrix does not contain antibiotics while the other shingles vaccine, Zostavax, does).

As it concerns the flu vaccine, it is important to remember that there isn't just one single flu vaccine product, but many.

For the 2019-2020 season, the following flu vaccines are available on the market:

  • Afluria Quadrivalent
  • Fluarix Quadrivalent
  • Flucelvax Quadrivalent
  • FluLaval Quadrivalent
  • Fluzone Quadrivalent
  • Fluad
  • Fluzone High-Dose
  • Flublok Quadrivalent
  • FluMist Quadrivalent

Since there is more than one flu vaccine, we must consider all of them when answering the question of whether or not 'the flu shot' contains antibiotics.

When discussing flu vaccine ingredients, complicating matter, many of the flu vaccines listed above come in multiple forms.

Flucelvax Quadrivalent for example, is available as a multi-dose vial and a pre-filled syringe. The multi-dose vial contains a preservative while the pre-filled syringe does not.

What I'm essentially trying to illustrate here is that there are many different flu vaccine products, each with their own unique list of ingredients.

Getting into the specifics of your question, many flu vaccine products do contain antibiotics, but they are not the commonly used ones.

I'll list the antibiotic components of the 2019-2020 flu vaccine products in the next section, but the only antibiotics that are potentially contained in flu vaccines (not all products, just some) are:

Again, these antibiotics are not in all flu vaccines, just some products.

The question of antibiotics in flu vaccines has actually been covered fairly extensively by the Immunization Action Coalition, which is supported by the Centers for Disease Control.

In their 'Ask The Experts' section, they published the following Q+A:

Q: The Vaccine Information Statement for inactivated influenza vaccine states that you should not get the vaccine if you are severely allergic to antibiotics. Which antibiotics are they referring to?

A:The antibiotics, of which there are trace amounts in some influenza vaccines, are neomycin, gentamicin, and polymyxin B. You should check each product's package insert information to see which, if any, antibiotics are listed.

The antibiotics you mentioned in your question, however, are of no concern here.

No flu vaccine contains penicillin, cephalexin, ciprofloxacin, Biaxin (clarithromycin) or their derivatives. So, even if you have an allergy to any of those antibiotics, you can still safely get any flu vaccine product.


Antibiotics In Flu Vaccines

In this section, I'll list each flu vaccine and state which antibiotics they contain (if they contain any at all). The following information is from the prescribing information for each respective product.

Afluria Quadrivalent Antibiotics

  • Neomycin sulfate (≤ 81.8 nanograms [ng])
  • Polymyxin B (≤ 14 ng)

Fluarix Quadrivalent Antibiotics

  • Gentamicin sulfate 0.15 mcg

Flucelvax Quadrivalent Antibiotics

Neither the Flucelvax Quadrivalent pre-filled syringe nor the multidose vial contain antibiotics. The prescribing information specifically makes note of this:

FLUCELVAX QUADRIVALENT 0.5 mL pre-filled syringes contain no preservative or antibiotics.

FLUCELVAX QUADRIVALENT 5 mL multi-dose vial formulation contains thimerosal, a mercury derivative, added as a preservative. Each 0.5 mL dose from the multi-dose vial contains 25 mcg mercury. FLUCELVAX QUADRIVALENT 5 mL multi-dose vial formulation contains no antibiotics.

FluLaval Quadrivalent Antibiotics

Neither the pre-filled syringe nor the multidose vial of FluLaval Quadrivalent contain antibiotics, and the prescribing information points this out:

Antibiotics are not used in the manufacture of this vaccine.

Fluzone Quadrivalent Antibiotics

Neither the pre-filled syringe nor the multidose vial of Fluzone Quadrivalent contain antibiotics. Per the prescribing information:

Antibiotics are not used in the manufacture of Fluzone Quadrivalent.

Fluad Antibiotics

  • Neomycin (≤ 0.02 mcg by calculation)
  • Kanamycin (≤ 0.03 mcg by calculation)

Fluzone High-Dose Antibiotics

Fluzone pre-filled syringes do not contain antibiotics per the prescribing information:

Neither antibiotics nor preservative are used in the manufacture of Fluzone High-Dose.

Flublok Quadrivalent Antibiotics

Flublok Quadrivalent does not contain any antibiotics. Per the prescribing information:

Flublok Quadrivalent contains no egg proteins, antibiotics, or preservatives. The single-dose, pre-filled syringes contain no natural rubber latex

FluMist Quadrivalent Antibiotics

  • Gentamicin sulfate (<0.015 mcg/mL)

Final Words

As you can see in the sections above, some flu vaccine products contain antibiotics, but in very trace amounts.

Nevertheless, if you have a known allergy to an antibiotic contained in a vaccine (or any other ingredient), it would be prudent to avoid it since there are other options that are antibiotic free.


Summary

  • Some flu vaccine products contain antibiotics (e.g. neomycin, gentamicin) while others do not.
  • Flucelvax Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent, Fluzone High Dose and Flublok Quadrivalent flu vaccines do not contain any antibiotics.
  • No flu vaccine contains penicillin, ciprofloxacin, cephalexin or clarithromycin. If you have an allergy to any of these antibiotics, you can still safely get the flu shot.

  • References
    1. Flucelvax Quadrivalent Prescribing Information.Seqirus
    2. Ask The Experts.Immunize.org
    3. Fluarix Quadrivalent Prescribing Information. GSK
    4. Afluria Quadrivalent Prescribing Information. FDA
    5. FluLaval Quadrivalent Prescribing Information. GSK
    6. Fluzone Quadrivalent Prescribing Information. FDA
    7. Fluad Prescribing Information. FDA
    8. Fluzone High Dose Prescribing Information. FDA
    9. Flublok Quadrivalent Prescribing Information. FDA
    10. Flumist Quadrivalent Prescribing Information. AstraZeneca