From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotics should be used to treat infections in patients on immunotherapy when clinically indicated, following standard treatment protocols for the specific infection, with a preference for cefepime/enmetazobactam or carbapenems over piperacillin/tazobactam for complicated urinary tract infections or acute pyelonephritis, as supported by the most recent study 1. For bacterial infections, empiric therapy should be initiated based on the suspected source, with common first-line options including:
- Amoxicillin-clavulanate 875/125 mg twice daily
- Cephalexin 500 mg four times daily
- Ciprofloxacin 500 mg twice daily for 7-14 days depending on infection severity and response Immunotherapy (checkpoint inhibitors like pembrolizumab or nivolumab) should generally be temporarily held during severe infections (grade 3-4) but can often continue during mild to moderate infections. It's essential to obtain appropriate cultures before starting antibiotics when possible and to narrow therapy once pathogens are identified. Patients on immunotherapy may present with immune-related adverse events that can mimic infection, so careful differential diagnosis is crucial, as highlighted in a study on the role of immunotherapy in bacterial infections 2. Prolonged antibiotic courses may be necessary in immunocompromised patients, and close monitoring for response is required. A pharmacodynamic analysis of various antibiotics, including cefepime, ceftazidime, and piperacillin/tazobactam, has shown that the choice of antibiotic should consider local epidemiology and the likelihood of microbiological success 3. Communication between oncologists and infectious disease specialists is vital to balance infection management with cancer treatment goals, particularly in immunocompromised patients where the risk of microbiological failure is higher with certain antibiotics, such as piperacillin/tazobactam, compared to cefepime or carbapenems 4.