Vivotif Drug Interactions: What to Avoid and What to Tell Your Doctor

Because Vivotif contains live bacteria, its drug interaction profile is unique compared to most medications. Certain drugs — particularly antibiotics and immunosuppressants — can kill or suppress the vaccine organism before your immune system has a chance to respond, rendering the vaccine ineffective. Knowing these interactions before you start your Vivotif series is essential.

The Core Problem: Vivotif Contains Live Bacteria

The Ty21a bacteria in Vivotif need to briefly colonize your small intestine to work. Any substance that kills bacteria (antibiotics) or suppresses the immune response (immunosuppressants) can prevent the vaccine from working as intended. This is why the interaction list for Vivotif focuses heavily on these two drug classes.

Category 1: Antibiotics and Sulfonamides (Contraindicated)

Do not take Vivotif while on any antibiotic or sulfonamide with activity against S. typhi. This includes virtually all common antibiotic classes:

Fluoroquinolones: Ciprofloxacin (Cipro), levofloxacin (Levaquin)

Macrolides: Azithromycin (Zithromax), clarithromycin (Biaxin)

Cephalosporins: Ceftriaxone, cefprozil, ceftaroline

Penicillins: Amoxicillin, ampicillin

Clindamycin, chloramphenicol

Sulfonamides: Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Recommendation: Complete your full antibiotic course before starting Vivotif. Wait at least 3 days after the last antibiotic dose before taking your first Vivotif capsule.

Category 2: Antimalarial Drugs (Major — Varies by Drug)

Many travelers taking Vivotif are also taking malaria prevention medication, which creates an important interaction question. The interactions differ by drug:

Proguanil (Malarone/atovaquone-proguanil) — Major interaction: A study of 30 individuals showed that proguanil 200 mg/day taken concurrently with Vivotif significantly reduced the immune response to the vaccine. Do not start Malarone until at least 10 days after your last Vivotif dose.

Mefloquine (Lariam) — Minor/safe: Clinical data show that mefloquine can be administered concurrently with Vivotif without significant impairment of immunogenicity.

Chloroquine (Aralen) — Minor/safe: Similar to mefloquine, clinical studies support concurrent administration with Vivotif.

If you're taking Malarone for malaria prevention: complete your entire Vivotif series, then wait at least 10 days before starting Malarone. Plan your pre-travel timeline accordingly.

Category 3: Immunosuppressants and Biologics (Contraindicated)

Vivotif is contraindicated in patients receiving immunosuppressive therapy. This includes:

Corticosteroids (high-dose): Prednisone, budesonide, hydrocortisone, triamcinolone

DMARDs: Methotrexate, hydroxyurea, azathioprine (Imuran)

Biologics: Belimumab (Benlysta), certolizumab (Cimzia), etanercept (Enbrel), baricitinib, brodalumab

Anti-cancer therapies: Chemotherapy, radiation therapy, ibrutinib

CAR-T and transplant therapies: Axicabtagene ciloleucel and other cellular therapies, antithymocyte globulin, basiliximab

For patients on these medications, Typhim Vi (injectable inactivated vaccine) is the recommended alternative, as it does not contain live organisms.

What to Tell Your Doctor Before Starting Vivotif

Before your pre-travel appointment, make a list of every medication you take — including:

All prescription antibiotics (including any you're taking for acne, UTI, or other conditions)

Malaria prevention drugs — especially if you plan to use Malarone

Biologic medications for arthritis, psoriasis, Crohn's, or other immune conditions

Any recent or upcoming vaccines (live vaccines generally should be spaced at least 4 weeks apart)

On a medication that interacts with Vivotif? See our guide on alternatives to Vivotif — particularly Typhim Vi. And when you're ready to find Vivotif at a nearby pharmacy, medfinder can call ahead for you.