Is It Safe To Take Antibiotics With Tamiflu?

In our latest question and answer, the pharmacist discusses why the use of antibiotics and Tamiflu is generally considered safe.

Question

Is it safe to take antibiotics while taking Tamiflu? I have the flu but I’m on my fourth day of Tamiflu and have an awful earache.

Asked by Mon On Apr 10, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Apr 10, 2019
Tamiflu box with text - Can you take antibiotics with Tamiflu

Overview

Yes, it is safe to take antibiotics with Tamiflu (oseltamivir). There are no known interactions between any antibiotic drug and Tamiflu.

It is important to remember, that antibiotics aren't effective against the flu as it is a viral infection. Nevertheless, if you have a bacterial infection you are treating at the same time as the flu (such as an ear infection), there should be no issue using an antibiotic and Tamiflu at the same time.

How They Work

Antibiotics are used for bacterial infections and work by either killing bacteria directly (i.e. bacteriocidal) or by inhibiting their reproduction (i.e. bacteriostatic).[1]

Tamiflu, on the other hand, is an antiviral medication, technically classified as a neuraminidase inhibitor.

It works by inhibiting the neuraminidase enzyme, which prevents the spread of the virus, and studies show that it has activity against both influenza (i.e. flu) A and B viruses.[2][3]

Antibiotics And Tamiflu Are Safe Together

Since Tamiflu and antibiotics (regardless of their class) have different mechanisms of action and work on different infective agents (viruses and bacteria respectively), they do not inhibit and decrease the others effect.

In addition, there are no known pharmacokinetic interactions between Tamiflu and antibiotic drugs.

A pharmacokinetic interaction refers to one drug potentially affecting any number of properties of another, including their:

  • Absorption
  • Distribution (in the body and various tissues)
  • Metabolism
  • Excretion

In fact, there are several published studies that show that there may actually be a benefit to using both Tamiflu and antibiotics in certain situations.

Tamiflu With Antibiotic Studies

One such study, published in the journal Clinical Infectious Diseases, found that Tamiflu reduced the risk of lower respiratory tract complications (e.g. respiratory failure, sepsis) in those taking antibiotics by 28%.[4]

Another study evaluated the combined use of azithromycin, a macrolide antibiotic, and Tamiflu.

The study found that their combined used was likely responsible for providing an early resolution of several flu-related symptoms, such as fever and sore throat. The study did not find however, any reduction in inflammatory markers that were being tested for more data was needed to make a firm conclusion on the benefits of the combination.[5]

Most studies looking at the combined use of Tamiflu and antibiotics note that they are well tolerated. However, since both often cause gastrointestinal problems (e.g. nausea, diarrhea), there is a chance that these side effects could happen more often.

Tamiflu Drug Interactions

As discussed above, Tamiflu does not interact with antibiotics and actually has very few drug interactions at all.

The only one the prescribing information states is with live flu vaccines, since Tamiflu may reduce our immune response to them. Inactivated flu vaccines (the most commonly used) are fine to use though.

Another potential interaction is with the drug probenecid.

Studies show that coadministration of Tamiflu and probenecid can cause more than a two-fold increase in Tamiflu concentrations. Nevertheless, this interaction is thought to be minor due to the relative lack of side effects caused by Tamiflu. If anything, there may be a slightly increased risk of nausea and related gastrointestinal side effects.[6]

Final Words

Overall, if you have been prescribed an antibiotic and are also taking Tamiflu, they are safe together.

They should be prescribed for different illnesses though since antibiotics only treat bacterial infections and Tamiflu is only indicated to treat the flu (it can also be used as a prophylaxis for flu infection).

Summary

There is no known drug interaction between Tamiflu and antibiotic medications. They can safely be used together.

References
  1. ^ Action and resistance mechanisms of antibiotics: A guide for clinicians. PubMed
  2. ^ Tamiflu Prescribing Information
  3. ^ Elsevier ClinicalKey: Tamiflu Monograph. ClinicalKey (Subscription Required)
  4. ^ Oseltamivir and Risk of Lower Respiratory Tract Complications in Patients With Flu Symptoms: A Meta-analysis of Eleven Randomized Clinical Trials. PubMed
  5. ^ Efficacy of Combination Therapy with Oseltamivir Phosphate and Azithromycin for Influenza: A Multicenter, Open-Label, Randomized Study. PubMed
  6. ^ Pharmacokinetics and Tolerability of Oseltamivir Combined with Probenecid. PubMed

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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