Alcoholic Drinks and Antibiotics - What Are the Risks?

Everyone has heard that we should not drink alcohol if you're taking any antibiotic. Among propagated reasons why this combination is avoided is the loss of effectiveness of the antibiotic, the increased alcohol toxicity, the occurrence of side effects and even an increased risk of liver damage.


A simple Google search by "alcohol and antibiotics" allows us to find dozens of sites that preach unrestricted abstaining from alcohol for patients under antibiotic treatment. Many of these sites cite medical and scientific explanations for alleged bring the risk of that association.

Unfortunately, the Internet is full of pseudo-scientific articles, which in the eyes of the lay population may seem well grounded, but who lack minimum scientific evidence to defend their views.

In the light of current scientific knowledge, there is no single answer to the question "who is taking antibiotics can drink?". For this response to be made correctly, we need to know what is the antibiotic that is being taken, that infection is being treated, what is the clinical status of the patient and what amount of alcohol that individuals want to take.

To sum up in one sentence all that will be explained in this article, we can say that for most patients and for most classes of antibiotics, there is no problem in drinking alcohol so moderate during the course of antibiotics.

Our text will be divided into the following topics:

• Why the mix of alcohol and antibiotics can not be a good idea.
• Antibiotics which contraindicate alcohol.
• What is the effect of disulfiram.
• Antibiotics that ALLOW alcohol moderately.
• Clinical situations which should discourage the mixture of alcohol and antibiotics.

Occasional and moderate amounts of alcohol as a social consumer 2 glasses of wine or beer cans 2 (or 1 dose of spirits) cause no interference with the effect of most antibiotics. In fact, even higher doses of alcohol tend not to cut the effect of the antibiotic. The problem, as we shall see, are the side effects and the action of alcohol on the immune system.

In principle, the idea that it is necessary a complete abstinence during the antibiotic treatment is a myth. And this is not a personal opinion, the very British Medical Association (BMA) does not impose any restriction on the association of alcohol with most antibiotics (exceptions will be explained later). Interestingly, this myth is quite common even among doctors. A study in Britain showed that up to 76% of doctors believe the searched alcohol mixture with antibiotics should be prohibited in all cases without exception.

It should be noted, however, that even if drinking is not prohibited during use of most antibiotics, this mixture, especially at high doses, is not exactly an action free of consequences.

The alcohol is a very irritant to the gastrointestinal mucosa, and to some common antibiotics such as amoxicillin and azithromycin, often lead to frame nausea, vomiting, abdominal pain or diarrhea, the mixture of high doses of alcohol with antibiotics is not recommended by leveraging these adverse effects. If you're sick and taking antibiotics, it is much more likely that alcohol causes adverse effects.

Another potential problem of this association is the fact that patients needing antibiotics are those with an infection and therefore in need of a competent immune system to fight it. A beer or two might not hinder in any way the body's ability to fight infections, but high amounts of alcohol can indeed impair the action of the immune system, making it difficult to cure the disease.

Another point that should be highlighted is the fact that alcohol is a substance that is metabolized in the liver by the same enzymatic pathways that metabolize some of the antibiotics. This is repeated excessive alcohol consumption can leave the liver "busy" processing the excess alcohol, causing the antibiotic is not suitably metabolized. This may cause not only a reduction of the action of antibiotics, but also the accumulation of toxic metabolites thereof, increasing the incidence of side effects.

In short, you can even take your beer or the usual glass of wine during a meal, even if it is under antibiotic treatment. But if you are sick, it is wise to avoid alcohol as well as smoking, excessive physical stress, poor eating, sleeping a few hours a night and excessive sun exposure. There is therefore, in most cases, a formal contraindication, it's just a matter of common sense.

Despite the association between alcohol and antibiotics be secure in most cases, there are important exceptions. Some classes of antibiotics can undergo relevant interaction, even with low doses of alcohol. In others, such as metronidazole and tinidazole, can cause serious side effects, known as disulfiram effect (explain further on what that effect).

So if you feel good, have a party scheduled for the weekend, want to drink responsibly, but is in the final stages of a course of antibiotics, the best option is to search if your antibiotic is part of the small group of medicines that contraindicate the consumption of alcoholic beverages.

Antibiotics that NO can in no way be mixed with alcohol are those that can cause disulfiram effect. Are they:

• Metronidazole
• Tinidazole
• Cefotetan

Even metronidazole or tinidazole cream for vaginal application can cause disulfiram effect. It is important to note that many gynecological creams may have 2 or 3 different substances in its composition, with metronidazole or tinidazole one.

To avoid the disulfiram effect, the patient must be for at least 72 hours without taking antibiotics to be able to consume any alcohol.

Rarely, the antibiotic sulfamethoxazole trimethoprim, known as Bactrim, can also cause disulfiram effect. Typically, this occurs only if the patient abuse in alcoholic beverages. However, for security, although it is rare, if you are taking Bactrim, the safest thing is to avoid alcohol.

In addition to antibiotics, other drugs used in the treatment of infections such as antiviral, antiparasitic and antifungal agents can also cause side effects when mixed with alcohol. Among them, the most important are:

• Griseofulvin (antifungal): may cause disulfiram effect.
• Voriconazole (antifungal): interfere with the effect of antifungal.
• Ketoconazole (antifungal): increases the risk of liver damage.
• Didanosine (antiretroviral): Increases the risk of pancreatitis.

The antibiotics mentioned above are those that may cause more severe reactions if ingested along with alcohol. However, there are still some more antibiotics can cause other types of reaction, and therefore should also be prevented from association with alcoholic beverages. Are they:

• Linezolid: may cause hypertensive crisis when consumed along with rich liquor tyrosine as beer or wine red.
• Isoniazid, rifampin and pyrazinamide: these drugs have an increased risk of liver toxicity (liver damage), so the use alcohol, especially frequent basis, should be discouraged.
• Erythromycin or doxycycline: alcohol can reduce the effectiveness of the antibiotic.

Disulfiram, commercially sold under the name Antabuse, is a substance used in the treatment of alcoholism. Disulfiram prevents the liver metabolizes most toxic metabolite of alcohol, increasing up to 10 times their toxicity to the organism. When the patient takes alcohol, even in small doses, it intoxicates quickly and feels the side effects such as vomiting, palpitations, heat, excessive sweating, difficulty breathing, severe headache and low blood pressure. The patient feels very uncomfortable, as if on the verge of collapse, so we could not continue drinking. If the patient insist on alcohol drinking, the drug can lead to coma or death.

Antibiotics cited in the previous section, especially metronidazole and tinidazole, can cause an effect similar to that of disulfiram. Therefore, the alcohol should be strongly discouraged for 24 hours prior to the start of treatment 72 hours after the end of antibiotic treatment.

So far, we quote 10 that antibiotics should not be mixed with alcohol. If you are taking an antibiotic that was not mentioned above, there is no scientific evidence to contraindication the moderate use of alcohol during treatment.

To be more precise, there is no formal contraindication to alcohol in small doses for those who are using amoxicillin, azithromycin, ciprofloxacin, levofloxacin, penicillin, cephalexin, ceftriaxone and other common antibiotics.

As we discussed earlier in the text, the fact that no formal contraindications to the use of alcohol and certain types of antibiotics does not mean that this association is completely safe. Remember, the patient under antibiotic treatment is ill and abuse alcohol will not do you any good.

If the patient is in a serious or potentially serious infection, it is obvious that the consumption of alcohol should be avoided, even if the beverage has no direct interaction with the antibiotic in progress. The issue is not the antibiotic itself, but rather the disease. The same reasoning applies to patients with any liver problems, even if temporary, because the alcohol-antibiotic combination may increase the hepatotoxicity of both.

Studies show that patients being treated for sexually transmitted infections (STIs) are at greater risk of having unprotected sex before course of antibiotics the end (before they are cured so), if they consume alcohol. This behavior endangers others and favors the spread of venereal diseases. Therefore, all patients with DST in treatment should avoid alcohol consumption.