Does amoxicillin affect Remicade (infliximab) infusion?

Amoxicillin Does Not Adversely Affect Remicade (Infliximab) Infusions

Amoxicillin does not negatively affect Remicade (infliximab) infusions and can be safely used concurrently when clinically indicated. 1

Safety of Amoxicillin with Infliximab

• Antibiotics, including amoxicillin, are not contraindicated during infliximab therapy and may actually be necessary in certain clinical scenarios 1
• Guidelines for biologic therapies specifically mention that treatment with infliximab can be restarted after resolution of febrile illness requiring antibiotics, without suggesting any direct interaction between antibiotics and the infusion itself 1
• There is no evidence in current guidelines suggesting that amoxicillin specifically interferes with the pharmacokinetics, efficacy, or safety of infliximab infusions 1

Clinical Scenarios Where Amoxicillin May Be Used with Infliximab

Prophylaxis for Infections

• Prophylactic antibiotics, including amoxicillin, may be used before infliximab infusions in patients with recurrent infections 2
• In a case report, prophylactic amoxicillin-clavulanic acid successfully prevented recurrent MSSA skin abscesses that developed after infliximab infusions 2

Treatment of Concurrent Infections

• Patients on infliximab who develop infections requiring antibiotic treatment should receive appropriate antibiotics, and infliximab can be temporarily withheld until resolution of the infection 1
• After completing the antibiotic course and resolution of infection symptoms, infliximab therapy can be safely restarted 1

Endocarditis Prophylaxis

• Amoxicillin remains the standard prophylactic agent for endocarditis prevention in at-risk patients undergoing procedures 1
• There are no contraindications to using amoxicillin for this purpose in patients receiving infliximab 1

Impact of Antibiotics on Infliximab Efficacy

• Recent research suggests that certain antibiotic classes may actually have beneficial effects on infliximab treatment durability 3
• Macrolides were associated with reduced risk of infliximab cessation (adjusted hazard ratio 0.72) 3
• While some antibiotics (fluoroquinolones and cephalosporins) were associated with increased risk of adalimumab cessation, no negative effects were observed with penicillins (the class to which amoxicillin belongs) 3

Management Considerations

• If a patient requires amoxicillin for an active infection, it is recommended to temporarily withhold infliximab until the infection resolves 1
• After completing the antibiotic course and resolution of infection symptoms, infliximab therapy can be safely resumed 1
• The necessity of repeating loading doses when restarting infliximab depends on disease severity and the number of doses missed 1
• Consider repeating loading doses if the patient is experiencing a disease flare or if more than 3-4 half-lives have passed since the previous dose 1

Conclusion

Amoxicillin can be safely administered to patients receiving infliximab therapy without concern for direct negative interactions with the infusion process. In some cases, prophylactic antibiotics including amoxicillin may even be beneficial for preventing infections in patients receiving infliximab.