Cephalosporins with a methylthiotetrazole (MTT) side chain or a methylthiodioxotriazine (MTDT) ring, ketoconazole, and griseofulvin have an increased risk of a disulfiram-like reaction. The disulfiram-like reaction, though classically associated with metronidazole, occurs with uncertain frequency and with varied severity. Alcohol low in tyramine may be consumed with oxazolidinones. Erythromycin may have reduced efficacy with alcohol consumption, and doxycycline may have reduced efficacy in chronic alcoholism. Data are equivocal for trimethoprim-sulfamethoxazole.
Available data support that oral penicillins, cefdinir, cefpodoxime, fluoroquinolones, azithromycin, tetracycline, nitrofurantoin, secnidazole, tinidazole, and fluconazole can be safely used with concomitant alcohol consumption. 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. It included studies that involved interactions, effects on efficacy, and toxicity/adverse drug reactions (ADR) due to concomitant alcohol consumption and antimicrobials. The search was conducted from inception of each database to 2018 using PubMed, Medline via Ovid, and Embase. The purpose of this systematic review was to determine the evidence behind alcohol warnings issued for many common antimicrobials. 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. Data regarding concurrent use are sparse.
Many antibiotics carry caution stickers that warn against alcohol consumption.
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