From the Guidelines
For patients taking Simponi (golimumab) who need antibiotic prophylaxis while traveling, azithromycin (single 1-gm dose or 500 mg daily for 3 days) is the recommended first-line option due to its efficacy against a broad range of pathogens, including those with fluoroquinolone resistance 1. When considering antibiotic prophylaxis for patients on Simponi, it's essential to prioritize the risk of infection and the potential consequences of treatment failure. Given the immune-suppressing nature of Simponi, patients are more susceptible to infections, and therefore, require effective antibiotic coverage. Some key points to consider when selecting an antibiotic for travel include:
- The likelihood of treatment efficacy and rapidity of response
- Regional patterns of probable target pathogens and their antimicrobial resistance
- Safety and tolerance profile of the antibiotic
- Simplicity of treatment regimen and patient adherence
- Cost Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1. Additionally, azithromycin has demonstrated effective and comparable cure rates with shigellosis, another common agent causing dysentery. While fluoroquinolones like ciprofloxacin or levofloxacin may be considered alternative options, their use is limited by the increasing prevalence of fluoroquinolone-resistant pathogens 1. Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to fluoroquinolones in non-invasive traveler's diarrhea caused by diarrheagenic E. coli, but its use is limited to non-invasive infections. Patients should carry azithromycin for self-treatment rather than taking it preventively throughout the trip and consult their rheumatologist or prescribing physician before travel to ensure the selected antibiotic doesn't interact with their specific medication regimen or medical conditions.
From the Research
Antibiotic Recommendations for Travel
When traveling, patients taking Simponi (golimumab) as an immune suppressant should be prepared for potential infections. The following antibiotics may be recommended as a precaution:
- Nitrofurantoin, fosfomycin, or pivmecillinam for urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria 2
- Oral cephalosporins such as cephalexin or cefixime, fluoroquinolones, and β-lactams like amoxicillin-clavulanate as second-line options for UTIs 2
- Azithromycin as an oral treatment option for Pseudomonas aeruginosa infections, particularly when fluoroquinolones are not possible due to resistance or patient intolerance 3
- Novel fluoroquinolones, new combinations of β-lactams/β-lactamase inhibitors, and cefiderocol as potential treatment options for P. aeruginosa infections 4
Considerations for Specific Infections
For community-acquired pneumonia, levofloxacin may be a suitable option, with lower treatment failure rates compared to azithromycin, especially in high-risk patients 5. For Pseudomonas aeruginosa infections, management focuses on prevention, obtaining cultures, and prompt initiation of antimicrobial therapy, occasionally with combination therapy depending on the clinical scenario 6.
Key Points to Consider
- Local susceptibility patterns and epidemiology should guide empiric antibiotic therapy 2, 4
- Antimicrobial stewardship is essential to preserve new drugs and prevent future resistance development 2, 4
- Patients taking Simponi should consult their healthcare provider for personalized antibiotic recommendations based on their specific travel plans and health status.