Fact versus Fiction: a Review of the Evidence behind Alcohol and Antibiotic Interactions

Abstract

Many antibiotics carry caution stickers that warn against alcohol consumption. Data regarding concurrent use are sparse. An awareness of data that address this common clinical scenario is important so health care professionals can make informed clinical decisions and address questions in an evidence-based manner. The purpose of this systematic review was to determine the evidence behind alcohol warnings issued for many common antimicrobials. The search was conducted from inception of each database to 2018 using PubMed, Medline via Ovid, and Embase. It included studies that involved interactions, effects on efficacy, and toxicity/adverse drug reactions (ADR) due to concomitant alcohol consumption and antimicrobials. All interactions were considered in terms of three components: (i) alteration in pharmacokinetics/pharmacodynamics (PK/PD) of antimicrobials and/or alcohol, (ii) change in antimicrobial efficacy, and (iii) development of toxicity/ADR. Available data support that oral penicillins, cefdinir, cefpodoxime, fluoroquinolones, azithromycin, tetracycline, nitrofurantoin, secnidazole, tinidazole, and fluconazole can be safely used with concomitant alcohol consumption. Data are equivocal for trimethoprim-sulfamethoxazole. Erythromycin may have reduced efficacy with alcohol consumption, and doxycycline may have reduced efficacy in chronic alcoholism. Alcohol low in tyramine may be consumed with oxazolidinones. The disulfiram-like reaction, though classically associated with metronidazole, occurs with uncertain frequency and with varied severity. Cephalosporins with a methylthiotetrazole (MTT) side chain or a methylthiodioxotriazine (MTDT) ring, ketoconazole, and griseofulvin have an increased risk of a disulfiram-like reaction. Alcohol and antimicrobial interactions are often lacking evidence. This review questions common beliefs due to poor, often conflicting data and identifies important knowledge gaps.

Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials

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“…However, it is not uncommon that some Vietnamese people to have a habit of drinking large amounts of alcohol, and being drunk may affect treatment adherence. In particular, when treated with regimens containing metronidazole or tinidazole, patients who drank alcohol during the treatment period are prone to severe side effects such as nausea, vomiting, headache, and flushing ( 49 ).…”

Advancing Endodormancy Release in Temperate Fruit Trees Using Agrochemical Treatments

“…However, despite all of these promising results, it must be said that hydrogen cyanamide is poisonous for humans—it can produce a disulfiram-like syndrome, in which acetaldehyde accumulates in the blood, producing headaches, low blood pressure, palpitations, nausea, and chest pain ( Mergenhagen et al, 2020 ). Its use has therefore been banned in many countries worldwide ( Sheshadri et al, 2011 ), including European Union countries, New Zealand, and more.…”