TABLE 4.
Summary of alcohol and antimicrobial interactions with a poor strength of evidence
| Antimicrobial | PK/PD | Efficacy | Toxicity/adverse drug reaction |
|---|---|---|---|
| Azithromycina | PK and efficacy unaffected (13). | No data | No data |
| Erythromycina | Delayed onset of action (29). | Potentially decreased efficacy as a result of increased rate of elimination (29). | Unclear; data are contrasting—possible risk of increased intoxication (30, 31). |
| Minocyclinea | No data | No data | No human data. Animal data suggest that minocycline reduces alcohol intake and alcohol-induced neurotoxicity in the developing brain (37, 38).b |
| Ciprofloxacina | No data | No data | One case of erythema multiforme reported (25). |
| Levofloxacina | Generally unaffected (24). | Generally unaffected (24). | No data |
| Moxifloxacin | Generally unaffected (24). | Generally unaffected (24). | No data |
| Fluconazolea | No data | No data | No data |
| Ketoconazolea | No data | No data | Disulfiram-like reaction (89, 90). Tachycardia, nausea, vomiting, flushing, or liver damage (4). Rash (90). |
| Griseofulvina | No data | No data | Disulfiram-like reaction (94–96). Potentiates alcohol’s effects; flushing and tachycardia (123). Reaction can be severe (97). |
| Tinidazole | No data | No data | Potential concern for disulfiram-like reaction due to chemical similarity to metronidazole (72). |
| Secnidazole | No effect on aldehyde dehydrogenase activity or ethanol metabolism (73). | No data | No data |
| Trimethoprim-sulfamethoxazolea | No data | No data | Disulfiram-like reaction, including flushing, heart palpitations, headache, and nausea in one case report (75). |
| Rifamycinsa | No data | No data | Concomitant use does not appear to increase risk of hepatotoxicity (101, 102, 117). Fatal and nonfatal overdose and toxicity have been reported in patients with current or past alcohol abuse (104). |
| Isoniazida | No data | No data | Hepatitis, peripheral neuropathy (124). Tachycardia, nausea, vomiting, headache, changes in blood pressure, flushing, or liver damage (4). Although data are not optimal, it is reasonable to advise avoidance of alcohol consumption in patients taking isoniazid. A disulfiram-like reaction and a possible increased risk of hepatitis are potential concerns. |
| Ethambutola | No data | No data | No data |
| Ethionamidea | No data | No data | Possible increased risk of hepatotoxicity (114). Mild liver impairment in the setting of alcohol abuse is not a contraindication to therapy (114). |
| Pyrazinamidea | No data | No data | Possible increased risk of hepatotoxicity (114). |
| Cycloserine | Decreased cravings for alcohol via enhancement of glutaminergic activity via N-methyl-d-aspartate (NDMA) receptors (119–121). | No data | Package insert warns of an increased risk of seizure, but the basis for this warning was not identified (122). |
a
Carries a risk of hepatoxicity.
b
Caution should be exercised as robust data are lacking.