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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
References
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => Early-life exposure to antibiotics can weaken the immune response to several routine vaccinations in infants, research has found.
Pharmacists may have had questions this week about antibiotic use in children following news articles highlighting the link between some antibiotics and vaccine efficacy. AP looks behind the headline to help pharmacists know how to respond
What’s driving this impairment?
Infants exposed to antibiotics in the neonatal period or first year of life had significantly lower antibody responses to vaccines including meningococcal ACWY and measles, mumps, rubella, found a study led by Australian experts.
The impact on antibody response is most likely due to disruptions in the development of gut bacteria.
‘We’ve known for some time that gut bacteria play an important role in shaping the immune system, but this study provides strong evidence that early life antibiotics can disrupt that process in a way that weakens vaccine responses,’ said Professor David Lynn, Professor of Systems Immunology at Flinders Health and Medical Research Institute, who co-led the study.
Infants who were treated with antibiotics had lower amounts of helpful gut bacteria at the time of vaccination, with Bifidobacteria particularly impacted. Children with this reduction in gut bacteria later showed weaker immune responses, indicated by reduced antibody levels at 6 and 14 months of age.
‘This suggests that these gut bacteria play a key role in helping the immune system respond optimally to vaccines,’ he said.
Interestingly, the study also found that babies whose mothers received antibiotics during labour did not have reduced vaccine responses.
‘This is an important distinction because it suggests that not all antibiotic exposure carries the same risks when it comes to the impact on the infant’s immune responses,’ Prof Lynn said. ‘[These findings] raise important questions about how we use antibiotics in newborns and what we can do to reduce any unintended consequences.’
What should pharmacists do?
Pharmacists should advise patients that routine vaccinations should not be postponed. At this stage, there have also not been changes to guidelines around antibiotic use. And antibiotics should also not be withheld when required, with infant infections often presenting as severe and requiring urgent treatment.
‘There’s usually a very good reason for giving the neonates those antibiotics, given that infections and sepsis in that critical early life period can be very serious,’ Prof Lynn told the Guardian.
Furthermore, infants treated with antibiotics still produce a sufficient immune response when vaccinated.
‘Around that 7-month time point, most of the infants are above what’s called the seroprotective threshold, so they will be expected to be protected against infection,’ Prof Lynn said.
‘What does seem to happen is that, over time, those responses wane a bit quicker in the infants that directly have antibiotics.’
The gut microbiome can also likely be repaired through the use of prebiotics and probiotics after antibiotic exposure, boosting impaired vaccine responses, found in an earlier preclinical study in mice led by Prof Lynn.
But antibiotics should continue to be used wisely.
‘In view of the importance of vaccination in maintaining health in society, this is yet another reason why antibiotics should be administered judiciously,’ said Associate Professor Peter Speck, from the College of Science and Engineering at Flinders University. ‘Antibiotic stewardship is clearly of great value, especially in the neonatal setting.’
What are the next steps?
While the findings are compelling, the authors acknowledge there are several limitations to the research . The study cohort was relatively small, and numbers in each antibiotic-exposed subgroup were even smaller.
Infants born by caesarean section or to mothers with a body mass index above 30 were excluded, so the results may not reflect the broader population seen in everyday practice. Immune responses were assessed with only limited functional assays and no detailed T cell analysis. Larger, more diverse studies will be needed to confirm and build on these early findings.
To that end, a human trial funded by the Women’s and Children’s Hospital Foundation is set to investigate if the infant immune response to vaccines can be improved by giving probiotics to babies treated with antibiotics in the first week of life.
‘This will provide evidence as to whether this simple probiotic intervention can support optimal immune responses to vaccination in early life, and we’ll also be able to identify the molecular mechanisms governing the differences in vaccine efficacy,’ Prof Lynn said.
‘Our findings could also be relevant to long-term child health, given prior associations between antibiotic exposure and an increased propensity to develop conditions such as allergies, asthma and obesity.’
Visit PSA’s Vaccination (Immunisation) Education Hub to access vaccination education and resources.
[post_title] => Early antibiotic use may blunt infant vaccine protection
[post_excerpt] => Early-life exposure to antibiotics can weaken the immune response to several routine vaccinations in infants, research has found.
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => Early-life exposure to antibiotics can weaken the immune response to several routine vaccinations in infants, research has found.
Pharmacists may have had questions this week about antibiotic use in children following news articles highlighting the link between some antibiotics and vaccine efficacy. AP looks behind the headline to help pharmacists know how to respond
What’s driving this impairment?
Infants exposed to antibiotics in the neonatal period or first year of life had significantly lower antibody responses to vaccines including meningococcal ACWY and measles, mumps, rubella, found a study led by Australian experts.
The impact on antibody response is most likely due to disruptions in the development of gut bacteria.
‘We’ve known for some time that gut bacteria play an important role in shaping the immune system, but this study provides strong evidence that early life antibiotics can disrupt that process in a way that weakens vaccine responses,’ said Professor David Lynn, Professor of Systems Immunology at Flinders Health and Medical Research Institute, who co-led the study.
Infants who were treated with antibiotics had lower amounts of helpful gut bacteria at the time of vaccination, with Bifidobacteria particularly impacted. Children with this reduction in gut bacteria later showed weaker immune responses, indicated by reduced antibody levels at 6 and 14 months of age.
‘This suggests that these gut bacteria play a key role in helping the immune system respond optimally to vaccines,’ he said.
Interestingly, the study also found that babies whose mothers received antibiotics during labour did not have reduced vaccine responses.
‘This is an important distinction because it suggests that not all antibiotic exposure carries the same risks when it comes to the impact on the infant’s immune responses,’ Prof Lynn said. ‘[These findings] raise important questions about how we use antibiotics in newborns and what we can do to reduce any unintended consequences.’
What should pharmacists do?
Pharmacists should advise patients that routine vaccinations should not be postponed. At this stage, there have also not been changes to guidelines around antibiotic use. And antibiotics should also not be withheld when required, with infant infections often presenting as severe and requiring urgent treatment.
‘There’s usually a very good reason for giving the neonates those antibiotics, given that infections and sepsis in that critical early life period can be very serious,’ Prof Lynn told the Guardian.
Furthermore, infants treated with antibiotics still produce a sufficient immune response when vaccinated.
‘Around that 7-month time point, most of the infants are above what’s called the seroprotective threshold, so they will be expected to be protected against infection,’ Prof Lynn said.
‘What does seem to happen is that, over time, those responses wane a bit quicker in the infants that directly have antibiotics.’
The gut microbiome can also likely be repaired through the use of prebiotics and probiotics after antibiotic exposure, boosting impaired vaccine responses, found in an earlier preclinical study in mice led by Prof Lynn.
But antibiotics should continue to be used wisely.
‘In view of the importance of vaccination in maintaining health in society, this is yet another reason why antibiotics should be administered judiciously,’ said Associate Professor Peter Speck, from the College of Science and Engineering at Flinders University. ‘Antibiotic stewardship is clearly of great value, especially in the neonatal setting.’
What are the next steps?
While the findings are compelling, the authors acknowledge there are several limitations to the research . The study cohort was relatively small, and numbers in each antibiotic-exposed subgroup were even smaller.
Infants born by caesarean section or to mothers with a body mass index above 30 were excluded, so the results may not reflect the broader population seen in everyday practice. Immune responses were assessed with only limited functional assays and no detailed T cell analysis. Larger, more diverse studies will be needed to confirm and build on these early findings.
To that end, a human trial funded by the Women’s and Children’s Hospital Foundation is set to investigate if the infant immune response to vaccines can be improved by giving probiotics to babies treated with antibiotics in the first week of life.
‘This will provide evidence as to whether this simple probiotic intervention can support optimal immune responses to vaccination in early life, and we’ll also be able to identify the molecular mechanisms governing the differences in vaccine efficacy,’ Prof Lynn said.
‘Our findings could also be relevant to long-term child health, given prior associations between antibiotic exposure and an increased propensity to develop conditions such as allergies, asthma and obesity.’
Visit PSA’s Vaccination (Immunisation) Education Hub to access vaccination education and resources.
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => Early-life exposure to antibiotics can weaken the immune response to several routine vaccinations in infants, research has found.
Pharmacists may have had questions this week about antibiotic use in children following news articles highlighting the link between some antibiotics and vaccine efficacy. AP looks behind the headline to help pharmacists know how to respond
What’s driving this impairment?
Infants exposed to antibiotics in the neonatal period or first year of life had significantly lower antibody responses to vaccines including meningococcal ACWY and measles, mumps, rubella, found a study led by Australian experts.
The impact on antibody response is most likely due to disruptions in the development of gut bacteria.
‘We’ve known for some time that gut bacteria play an important role in shaping the immune system, but this study provides strong evidence that early life antibiotics can disrupt that process in a way that weakens vaccine responses,’ said Professor David Lynn, Professor of Systems Immunology at Flinders Health and Medical Research Institute, who co-led the study.
Infants who were treated with antibiotics had lower amounts of helpful gut bacteria at the time of vaccination, with Bifidobacteria particularly impacted. Children with this reduction in gut bacteria later showed weaker immune responses, indicated by reduced antibody levels at 6 and 14 months of age.
‘This suggests that these gut bacteria play a key role in helping the immune system respond optimally to vaccines,’ he said.
Interestingly, the study also found that babies whose mothers received antibiotics during labour did not have reduced vaccine responses.
‘This is an important distinction because it suggests that not all antibiotic exposure carries the same risks when it comes to the impact on the infant’s immune responses,’ Prof Lynn said. ‘[These findings] raise important questions about how we use antibiotics in newborns and what we can do to reduce any unintended consequences.’
What should pharmacists do?
Pharmacists should advise patients that routine vaccinations should not be postponed. At this stage, there have also not been changes to guidelines around antibiotic use. And antibiotics should also not be withheld when required, with infant infections often presenting as severe and requiring urgent treatment.
‘There’s usually a very good reason for giving the neonates those antibiotics, given that infections and sepsis in that critical early life period can be very serious,’ Prof Lynn told the Guardian.
Furthermore, infants treated with antibiotics still produce a sufficient immune response when vaccinated.
‘Around that 7-month time point, most of the infants are above what’s called the seroprotective threshold, so they will be expected to be protected against infection,’ Prof Lynn said.
‘What does seem to happen is that, over time, those responses wane a bit quicker in the infants that directly have antibiotics.’
The gut microbiome can also likely be repaired through the use of prebiotics and probiotics after antibiotic exposure, boosting impaired vaccine responses, found in an earlier preclinical study in mice led by Prof Lynn.
But antibiotics should continue to be used wisely.
‘In view of the importance of vaccination in maintaining health in society, this is yet another reason why antibiotics should be administered judiciously,’ said Associate Professor Peter Speck, from the College of Science and Engineering at Flinders University. ‘Antibiotic stewardship is clearly of great value, especially in the neonatal setting.’
What are the next steps?
While the findings are compelling, the authors acknowledge there are several limitations to the research . The study cohort was relatively small, and numbers in each antibiotic-exposed subgroup were even smaller.
Infants born by caesarean section or to mothers with a body mass index above 30 were excluded, so the results may not reflect the broader population seen in everyday practice. Immune responses were assessed with only limited functional assays and no detailed T cell analysis. Larger, more diverse studies will be needed to confirm and build on these early findings.
To that end, a human trial funded by the Women’s and Children’s Hospital Foundation is set to investigate if the infant immune response to vaccines can be improved by giving probiotics to babies treated with antibiotics in the first week of life.
‘This will provide evidence as to whether this simple probiotic intervention can support optimal immune responses to vaccination in early life, and we’ll also be able to identify the molecular mechanisms governing the differences in vaccine efficacy,’ Prof Lynn said.
‘Our findings could also be relevant to long-term child health, given prior associations between antibiotic exposure and an increased propensity to develop conditions such as allergies, asthma and obesity.’
Visit PSA’s Vaccination (Immunisation) Education Hub to access vaccination education and resources.
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[post_content] => The Therapeutic Goods Administration (TGA) has today (Monday 1 December) made updates to product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists for two separate safety issues.
AP examines what pharmacists need to know.
ALERT 1: Potential risk of suicidal thoughts
The TGA has aligned product warnings for all GLP-1 RA medicines to ensure consistent information regarding the potential risk of suicidal thoughts or behaviours.
There have been growing questions about whether there’s a link between GLP-1 RAs and suicidal ideation. As of 23 September 2025, the TGA’s Database of Adverse Event Notifications (DAEN) contains the following:
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[post_content] => Australia’s east coast was belted with heavy storms last week. Spring and summer storms can trigger thunderstorm asthma – with bursts of pollen often causing sudden, severe asthma attacks, particularly in patients with asthma or allergic rhinitis.
‘There was the big event in Victoria in November 2016 when 10 people died,’ said Clinical Associate Professor Debbie Rigby FPS, pharmacist and Clinical Executive Lead, National Asthma Council Australia (NAC).
‘But there are other peaks that don’t get as much media coverage – for example, there was terrible weather on Melbourne Cup Day this year, and data showed there were over 100 emergency department (ED) admissions and ambulance callouts that day.’
When asthma symptoms spike, so do SABA (short-acting beta2-agonist) requests. With new guidelines that discourage overreliance on SABA, asthma expert A/Prof Rigby explains how pharmacists should manage these situations.
What do the new asthma guidelines say?
In the updated NAC Australian Asthma Handbook, released in September 2025, a key guideline change is that no adult or adolescent with asthma should be using salbutamol alone.
‘Every [adult or adolescent] with confirmed asthma now needs to be on an inhaled corticosteroid (ICS),’ A/Prof Rigby said.
The National Asthma Council recently released data that found there were 478 asthma-related deaths in 2024, equating to more than one per day.
There was a surprising increase in asthma deaths in the youngest patient cohort, those aged 0 to 35.
‘This is largely due to poorly controlled asthma, including people over-relying on SABA, not using preventers, or not using anti-inflammatory reliever therapy,’ Ms Rigby said. ‘Those with more severe symptoms should be on maintenance-and-reliever therapy, or MART.’
But that doesn't mean pharmacists should deny patients salbutamol, particularly during events such as storms that can trigger exacerbations.
‘Absolutely supply it if a patient has symptoms – it’s potentially life-saving during an acute episode – but we should be alluding to the fact that it’s risky to use salbutamol alone in asthma,’ she said. ‘‘Use it as an opportunity to explain that the guidelines have changed and that we now have better treatment, but also assess them to determine if they need to see a GP straightaway or go to ED.’
For example, if a patient can’t finish a sentence without taking a breath, they need immediate treatment.
Pharmacists should also remind patients that they should have an asthma action plan, which many adults don’t have. ‘Most people can manage with salbutamol in an acute situation – but they can also use budesonide-formoterol.’
It’s also important to point out the benefits of preventative and anti-inflammatory therapy, including improved asthma control and long-term health outcomes.
‘ICS–formoterol reduces the risk of severe episodes, it's more convenient because you only carry one inhaler and even has environmental benefits,’ A/Prof Rigby said. ‘There are about 15 million salbutamol inhalers used annually, which is a significant carbon footprint.’
What can pharmacists do?
A lot has been learned since the 2016 thunderstorm asthma event, A/Prof Rigby said.
‘The Victoria Department of Health has been very proactive with the pollen-alert apps that give daily high-pollen warnings,’ she said.
There are also similar systems in other states; these apps provide a daily alert using a traffic-light system across mapped regions.
‘For example [on Thursday], the Mildura area was “red” – very high pollen count,’ A/Prof Rigby said.
‘I encourage all pharmacists to sign up, but also to recommend them to patients with asthma and/or allergic rhinitis. When your area is on medium or high alert, pharmacists should be having conversations with patients about being prepared.’
This includes always having a reliever on hand – either salbutamol, or preferably, the anti-inflammatory reliever budesonide-formoterol.
‘During thunderstorm asthma – the “perfect storm” of high pollen plus thunderstorms – people should also avoid being outside, close windows, use air-conditioning, and in cars set air recirculation mode,’ she said.
And when patients present to the pharmacy for treatment for allergic rhinitis, pharmacists should ask: Do you have asthma?
‘Around 80% of people with asthma also have allergic rhinitis, and 40–60% of people with allergic rhinitis also have asthma,’ A/Prof Rigby said. ‘We need to think about “one airway, one disease.” If you get the nose under control, you get better asthma control – and vice versa.’
What’s the approach when it’s not asthma?
During the 2016 thunderstorm asthma event, many people who presented to pharmacies or EDs didn’t have diagnosed asthma, A/Prof Rigby said.
‘Many had hay fever or allergic rhinitis,’ she said. ‘So when people request hay fever treatments, pharmacists should ask about symptoms – such as shortness of breath, cough or chest tightness – which could indicate asthma.’
When these incidents occur, pharmacists should ask whether patients had childhood asthma, hay fever or other respiratory issues. They can also provide Asthma first aid.
‘You can supply a salbutamol puffer – ideally with a spacer – because when people are short of breath they’re less able to coordinate inhalation, and most people don’t use puffers correctly anyway,’ she said.
Pharmacists should use the 4x4x4 method: 4 puffs, one at a time, via a spacer; wait 4 minutes; repeat as needed.
‘If the patient is still short of breath, seek medical advice,’ A/Prof Rigby added. ‘And document everything.’
Pharmacists should also follow-up via phone, text or the next visit.
How should COPD be managed in a storm?
While asthma is reversible with good control, chronic obstructive pulmonary disease (COPD) involves persistent airway inflammation and irreversible obstruction.
Salbutamol may be used to relieve symptoms in patients with COPD, but it does not provide the same level of relief as it does in asthma, A/Prof Rigby said.
‘The perceived benefit of SABA for patients with COPD is often due to the person stopping and resting, or the anxiety relief of “doing something” – rather than actual bronchodilation,’ she said.
But patients with COPD are less likely to have their symptoms triggered by storms.
‘They may be short of breath at rest and have reduced exercise tolerance, so they must take preventative therapy regularly,’ A/Prof Rigby said.
This includes regular use of a long-acting muscarinic antagonist and long-acting beta2-agonist.
‘Only some patients need triple therapy,’ she added.
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[post_content] => Allergic rhinitis (AR) remains a common but often underrecognised condition in Australian primary care1. Here’s what global experts shared at the 2025 FIP World Congress about how it should be managed.
With a prevalence of 23.9% in Australia,2 AR – commonly known as hay fever – significantly impacts patients’ quality of life, productivity, and often coexists with conditions such as asthma.3
The condition is caused by the nose and/or eyes coming into contact with allergens in the environment – such as pollens, dust mites, moulds and animal dander.2 When left untreated, AR can lead to complications including sleep disturbance, daytime tiredness, headaches, poor concentration, and recurrent ear or sinus infections.4
The role of pharmacists in AR management
Australian pharmacists play an increasingly vital role in the management of AR, supporting diagnostic differentiation, therapy optimisation and patient education in community settings.
Pharmacists can provide key interventions – including accurate symptom assessment, medicines recommendations and ongoing support for self-management.
Global updates: FIP 2025
At the 2025 FIP World Congress in Copenhagen, experts shared the latest evidence on AR management, highlighting innovations that can transform patient care. A key topic was the concept of antihistamines with 0% brain interference, such as fexofenadine. This antihistamine provides effective symptom relief without sedation, ensuring patients maintain cognitive performance and safety – critical for those operating machinery or driving.5
FIP President Paul Sinclair AM MPS, emphasised that pharmacists are uniquely positioned to lead AR management.
‘We know that people affected by AR can have their quality of life impacted quite dramatically, so it is important to intervene and recommend appropriate medication, which will relieve the symptoms and minimise the impact on somebody’s quality of life, so they can maintain all the things they need to do on a daily basis,’ he said
https://youtu.be/4no1XLK9TVs?si=dP-oEXSWEu_ohiJC
Watch on demand: 3rd Global Allergy Connect Meeting
Pharmacists in Australia can enhance their expertise in AR by accessing on-demand resources and lectures from the 2025 FIP World Congress. After registering with their professional details, pharmacists can view content from the 3rd Global Allergy Connect Meeting, where experts from the United Kingdom, Spain, and France discuss AR, antihistamines with 0% brain interference (such as fexofenadine), clinical evidence, and strategies for managing AR in community pharmacy settings.
For access:
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[post_content] => From mid-2027, the availability of dozens and dozens of complementary medicines containing vitamin B6 will change.
Yesterday (25 November 2025), the Therapeutic Goods Administration (TGA) released the final decision on the scheduling of vitamin B6 containing medicines in response to safety concerns following consideration of the advice of the Advisory Committee on Medicines Scheduling in November 2024 and public consultation.
What's changing?
The TGA Delegate’s final decision will see scheduling changes for products containing vitamin B6, dependent on the product’s vitamin B6 dose. This means oral preparations containing:
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[post_content] => Early-life exposure to antibiotics can weaken the immune response to several routine vaccinations in infants, research has found.
Pharmacists may have had questions this week about antibiotic use in children following news articles highlighting the link between some antibiotics and vaccine efficacy. AP looks behind the headline to help pharmacists know how to respond
What’s driving this impairment?
Infants exposed to antibiotics in the neonatal period or first year of life had significantly lower antibody responses to vaccines including meningococcal ACWY and measles, mumps, rubella, found a study led by Australian experts.
The impact on antibody response is most likely due to disruptions in the development of gut bacteria.
‘We’ve known for some time that gut bacteria play an important role in shaping the immune system, but this study provides strong evidence that early life antibiotics can disrupt that process in a way that weakens vaccine responses,’ said Professor David Lynn, Professor of Systems Immunology at Flinders Health and Medical Research Institute, who co-led the study.
Infants who were treated with antibiotics had lower amounts of helpful gut bacteria at the time of vaccination, with Bifidobacteria particularly impacted. Children with this reduction in gut bacteria later showed weaker immune responses, indicated by reduced antibody levels at 6 and 14 months of age.
‘This suggests that these gut bacteria play a key role in helping the immune system respond optimally to vaccines,’ he said.
Interestingly, the study also found that babies whose mothers received antibiotics during labour did not have reduced vaccine responses.
‘This is an important distinction because it suggests that not all antibiotic exposure carries the same risks when it comes to the impact on the infant’s immune responses,’ Prof Lynn said. ‘[These findings] raise important questions about how we use antibiotics in newborns and what we can do to reduce any unintended consequences.’
What should pharmacists do?
Pharmacists should advise patients that routine vaccinations should not be postponed. At this stage, there have also not been changes to guidelines around antibiotic use. And antibiotics should also not be withheld when required, with infant infections often presenting as severe and requiring urgent treatment.
‘There’s usually a very good reason for giving the neonates those antibiotics, given that infections and sepsis in that critical early life period can be very serious,’ Prof Lynn told the Guardian.
Furthermore, infants treated with antibiotics still produce a sufficient immune response when vaccinated.
‘Around that 7-month time point, most of the infants are above what’s called the seroprotective threshold, so they will be expected to be protected against infection,’ Prof Lynn said.
‘What does seem to happen is that, over time, those responses wane a bit quicker in the infants that directly have antibiotics.’
The gut microbiome can also likely be repaired through the use of prebiotics and probiotics after antibiotic exposure, boosting impaired vaccine responses, found in an earlier preclinical study in mice led by Prof Lynn.
But antibiotics should continue to be used wisely.
‘In view of the importance of vaccination in maintaining health in society, this is yet another reason why antibiotics should be administered judiciously,’ said Associate Professor Peter Speck, from the College of Science and Engineering at Flinders University. ‘Antibiotic stewardship is clearly of great value, especially in the neonatal setting.’
What are the next steps?
While the findings are compelling, the authors acknowledge there are several limitations to the research . The study cohort was relatively small, and numbers in each antibiotic-exposed subgroup were even smaller.
Infants born by caesarean section or to mothers with a body mass index above 30 were excluded, so the results may not reflect the broader population seen in everyday practice. Immune responses were assessed with only limited functional assays and no detailed T cell analysis. Larger, more diverse studies will be needed to confirm and build on these early findings.
To that end, a human trial funded by the Women’s and Children’s Hospital Foundation is set to investigate if the infant immune response to vaccines can be improved by giving probiotics to babies treated with antibiotics in the first week of life.
‘This will provide evidence as to whether this simple probiotic intervention can support optimal immune responses to vaccination in early life, and we’ll also be able to identify the molecular mechanisms governing the differences in vaccine efficacy,’ Prof Lynn said.
‘Our findings could also be relevant to long-term child health, given prior associations between antibiotic exposure and an increased propensity to develop conditions such as allergies, asthma and obesity.’
Visit PSA’s Vaccination (Immunisation) Education Hub to access vaccination education and resources.
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
