Can a patient with an allergy to Tobrex (tobramycin) and gentamicin receive the flu vaccine?

Influenza Vaccination for Patients with Tobramycin and Gentamicin Allergies

Patients with allergies to tobramycin and gentamicin can safely receive any influenza vaccine, as these aminoglycoside antibiotics are not components of influenza vaccines. 1

Understanding Aminoglycoside Allergies and Vaccine Components

• Tobramycin and gentamicin are aminoglycoside antibiotics used to treat various bacterial infections, particularly those caused by Gram-negative bacteria and some Staphylococcus species 2
• These antibiotics are not used in the manufacturing process of influenza vaccines and are not present as components in any influenza vaccine formulations 1
• The main contraindication for influenza vaccination is a history of severe allergic reaction (anaphylaxis) to a previous dose of influenza vaccine or to any component of the vaccine 1

Potential Allergens in Influenza Vaccines

• Common allergens in influenza vaccines that may cause reactions include:

  • Egg protein (in egg-based vaccines) 1
  • Gelatin (used as a stabilizer in some vaccines) 1
  • Neomycin (another aminoglycoside antibiotic present in trace amounts in some vaccines) 1
  • Thimerosal (a preservative in multi-dose vials of some influenza vaccines) 1

• While neomycin (another aminoglycoside) is present in trace amounts in some vaccines, cross-reactivity between aminoglycosides is primarily a concern for systemic administration rather than the trace amounts found in vaccines 1

Vaccine Selection Considerations

• For patients with aminoglycoside allergies who are concerned about potential cross-reactivity:

  • Cell culture-based inactivated influenza vaccine (ccIIV) or recombinant influenza vaccine (RIV) can be considered as they do not contain antibiotics in their manufacturing process 1
  • Review the specific vaccine package insert to confirm absence of aminoglycosides in the particular formulation 1

• Standard precautions that apply to all vaccinations should be followed:

  • Vaccination should be administered in settings where personnel and equipment for managing allergic reactions are available 1
  • Providers should be certified in cardiopulmonary resuscitation 1
  • Consider observing patients for 15 minutes after vaccination to monitor for syncope or immediate reactions 1

Special Considerations

• If the patient has had previous allergic reactions to influenza vaccines, further evaluation is warranted:

  • For severe previous reactions to any influenza vaccine, consultation with an allergist is recommended 1
  • If the patient has multiple drug allergies or history of severe drug reactions, vaccination should occur in an appropriate medical setting with supervision 1

• Mild illness, with or without fever, is not a contraindication to influenza vaccination 3

• Moderate to severe illness is a precaution, and vaccination should be deferred until resolution of symptoms 1, 3

Remember that the benefits of influenza vaccination generally outweigh the risks, especially for individuals at higher risk for influenza complications 1.