Why you can’t drink alcohol with antibiotics – the pharmacist answers

There are two types of patients on antibiotic therapy: those who completely abstain from drinking alcohol while on antibiotics, and those who skip a dose of the drug after drinking a glass of wine, beer, or something stronger. Considering that in most cases the course is from three to seven days, during this period it is not so difficult to limit yourself to alcohol. But is this refusal mandatory, is it so scary to use antibiotics along with alcohol – a topic that should be carefully understood.

Why there is an opinion about the incompatibility of alcohol with antibiotics

Of course, it is worth remembering that large doses of alcohol are generally not good for the body, but, on the other hand, scientists and doctors have proven that most antibiotics can be taken with a small amount of low-alcohol drinks. There are no contraindications to this, but this situation is not with all antibacterial agents. It is necessary to refrain from alcoholic beverages if the doctor has prescribed a medicine with the following active ingredients:

• cefamandole;
• chloramphenicol;
• cefotetan;
• isoniazid;
• metronidazole;
• griseofulvin;
• linezolid;
• sulfamethoxazole;
• nitrofurantoin;
• doxycycline. ^[1]

With a combination of drugs based on these substances, the breakdown of alcohol slows down, resulting in an increase in the level of acetaldehyde. The patient feels a whole range of unpleasant symptoms: nausea, headache, shortness of breath, chest pain, redness of the face. This state of affairs can be very frightening.

The myth of the complete incompatibility of antibiotics and alcohol dates back to the last century. Interestingly, he has two explanations at once. According to the first, this was facilitated by doctors who, as a punishment for the immoral behavior of patients with sexually transmitted infections, forbade the intake of alcohol during antibiotic therapy, frightening with serious consequences.

The second theory of the origin of the myth is also associated with the prohibitions of doctors. It was explored by James Bingham, who met with one of the brigadiers of the British army that participated in the Second World War. Doctors treated wounded soldiers with scarce and expensive penicillin. Since there were not enough drugs for everyone, the antibiotic was extracted from the patient’s urine. Given the increase in the amount of urine after drinking beer and the decrease in the concentration of the antibacterial drug, which complicated its extraction, doctors forbade even recovering soldiers from drinking strong and low-alcohol drinks. ^[2] However, even now, patients continue to be afraid to drink alcohol during antibiotic therapy, and doctors continue to recommend abstaining from it.

To drink or not to drink

Despite the fact that many groups of antibiotics do not actually interact with alcohol, you should not drink them together. And there are several explanations for this:

1. A double blow to the liver: both medicines and alcoholic beverages are excreted by this organ, so sharing harms it. In particular, under the influence of ethyl alcohol, the synthesis of fatty acids in liver cells – hepatocytes is disrupted. Antibiotics, in turn, can cause blockage of the bile duct. This happens with other human organs: kidneys, heart, stomach, intestines. It is especially important not to combine alcohol with antibiotics that have a high hepatotoxic effect (erythromycin, amoxicillin, gatifloxacin, flucloxacillin, sulfamethoxazole). ^[3]
2. A change in the therapeutic effect, the possible occurrence of antibiotic resistance is a serious reason to refuse alcohol during treatment. The presence of alcohol in the blood reduces the concentration of the antibacterial drug, so it does not act on the infection in the dose that is needed. Recovery is delayed, and microorganisms become less sensitive to the antibiotic. At the same time, the intestines also suffer, since regular alcohol consumption increases inflammatory processes in it. The normal microflora is disturbed, which is why the unpleasant consequences of taking antibiotics are growing. ^[4].
3. The immune system, which is already weakened by the disease, suffers from alcohol. With the systematic use of alcoholic beverages, the synthesis of immunoglobulin is disrupted, the level of lysozyme, an enzyme that destroys the cell walls of bacteria and contributes to their death, decreases. In addition, ethyl alcohol causes inhibition of the hematopoietic process. White blood cells (leukocytes) lose their ability to resist pathogenic flora ^[5]. According to scientific tests, with a single use of alcohol, the protective functions of the body are “turned off” for 2-3 days, and antibiotics have to fight the disease on their own.

What is the best way to take antibiotics with alcohol in mind

First of all, you need to remember: any antibiotics should be prescribed by a doctor after a thorough diagnosis of the patient’s health status. It is absolutely impossible to start taking them on your own, otherwise the treatment may become ineffective, and the condition will worsen.

It is equally important to take into account the rules for taking antibacterial agents along with alcohol. There is nothing complicated about them:

• at least 24 hours must elapse before the first dose of the drug and the last use of alcoholic beverages;
• after the end of antibiotic therapy, it is worth abstaining from alcohol for 1-2 days;
• if the patient was in a binge, you need to wait at least half the time, the duration of drinking alcohol. For example, if alcohol was consumed for 6 days, you should refrain from treatment for 3 days. If the condition is critical, then before taking antibiotics, efferent therapy is necessary to remove the decay products of ethanol from the body. ^[6]

And even better – completely abandon the use of alcohol, because there is no safe dose. The exception is the periodic use of high-quality alcoholic beverages in small quantities.

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