TABLE 3.

Summary of alcohol and antimicrobial interactions with a moderate strength of evidence

Antimicrobiala	PK/PD	Efficacy	Toxicity/adverse drug reaction
Penicillins	No effect on PK/PD of penicillin; no difference in peak concentrations, absorption, or elimination (10). Amoxicillin has delayed absorption (increased Tmax, increased half-life); no significant difference in Cmax or area under the curve (11). Alcohol has influence on the rate but not on the extent of amoxicillin absorption (11).	No data	No data
Cephalosporins	No effect on ceftriaxone PK/PD in an animal model (13). Biliary excretion of cefadroxil was increased with acute alcohol consumption in an animal model (14). Urinary excretion of cephalexin was lowered with acute alcohol consumption in an animal model (14). Decreased cephalexin and cefadroxil absorption with acute alcohol consumption in an animal model (14). No difference in biliary excretion, urinary excretion, or absorption of cephalexin and cefadroxil with chronic alcohol consumption in an animal model (14).	No effect on treatment of pneumonia in animal models (13).	Cephalosporins with an MTT side chain or an MTDT ring have an increased risk of a disulfiram-like reaction (15–22).
Doxycycline	Half-life shorter in alcoholics (34). Decreased absorption with “cheap wine”; most effect in alcoholics (35). PK/PD may not be affected by whiskey (35).	Decreases efficacy of treatment of Brucella melitensis in animal models (36).	No data
Nitrofurantoina	No data	No data	Previous reports of disulfiram-like reaction have been disproven (43, 44).
Metronidazolea	No data	No data	Disulfiram-like reaction (46). No disulfiram-like reaction (48, 52–54, 56, 57, 59, 61). Modification or alteration of the taste of alcohol (46).
Linezolid	No data	No data	Increased systolic blood pressure of ≥30 mm Hg with consumption of high-tyramine-containing food or beverages (including tap beers and red wines) (83). ≥100 mg tyramine is required to increase systolic blood pressure by at least 30 mm Hg (81).
Tedizolid	No data	No data	Increased systolic blood pressure (≥30 mm Hg) with consumption of 325 mg tyramine (86).
Tetracycline	Enhanced absorption (increased Cmax and area under the curve) (33). No effect on elimination (33, 34).	No data	No data

^aCarries a risk of hepatoxicity.