Antibiotics are powerful medications designed to slow down or destroy bacteria growth. Antibiotics are prescribed to fight bacterial infections. They work by stopping bacteria from reproducing or through killing already existing and invading bacteria.
Antibiotics are necessary since foreign bacteria tend to invade the body excessively, making it difficult for the body’s own defense mechanism (white blood cells) to fight infections alone.
In this post, we will discuss the truths of drinking alcohol while taking a course of antibiotics. We will answer some of the most common questions such as can I skip my medication to drink alcohol, are there dangerous side-effects, and how long after taking antibiotics can I drink alcohol?
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Alcohol alters the work of antibiotics in the body. Since antibiotics are broken down or metabolized by enzymes present in the liver (and alcohol is also metabolized in the liver), drinking can slow down or increase liver enzymes resulting in a sharp increase or decrease of antibiotics circulating in the body. Alcohol makes antibiotics ineffective or causes toxicity. 
Alcohol can also increase the risk of suffering from the side effects of antibiotics. While antibiotics are known to cause side effects like rashes, drinking alcohol while taking antibiotics can cause bright red skin flushing. Side effects like drowsiness can become severe nausea.
Since antibiotics and alcohol both have side effects that can be severe, combining them isn’t recommendable. Drinking while on antibiotics can cause severe fatigue, heart palpitations, a throbbing headache, among other severe effects. Alcohol is also known to worsen digestive system-related side effects. Therefore, drinking while taking antibiotics prescribed for digestive system related issues is dangerous.
Alcohol can cause severe diarrhoea, uncontrollable vomiting, intense stomach pain, and fever when mixed with antibiotics meant to treat stomach-related issues. Alcohol combined with antibiotics can also cause organ damage (kidney and liver damage.)
Both alcohol and antibiotics burden the liver and kidneys.  Alcohol can also compromise the body’s immune system responses affecting the body’s recovery. Besides slowing down the healing process, alcohol can put a person at risk of getting new infections.
In typical circumstances, the immune system can kill harmful bacteria before it multiplies and causes illness. In some cases, the immune system may need assistance. That’s where antibiotics come in. Antibiotics kill or stop the growth of bacteria alongside the immune system.
Drinking compromises the immune system by reducing the number of white blood cells ready to defend the body against infection at any given time.
Drinking also compromises the production of cytokines – messenger molecules responsible for triggering an immune system response.  Since alcohol weakens the immune system, it’s easy to see why individuals suffering from alcohol addiction tend to suffer from bacterial infections like pneumonia and tuberculosis.
Antibiotics like Metronidazole are used to treat a variety of bacterial infections ranging from the lung to skin and stomach infections. Mixing Metronidazole and alcohol results in reactions similar to those of alcohol with disulfiram. The side effects can include chest pain, difficulty breathing, rapid heart rate, stomach cramps, vomiting, nausea, and skin flushing.
Antibiotics like Cefotan and Tindamax produce similar side effects when mixed with alcohol. Metronidazole can cause CNS-related side effects like dizziness, confusion, sedation, and drowsiness.
Many antibiotics are known to cause violent reactions when taken alongside alcohol. These reactions range from vomiting and nausea to dizziness, headaches, chest pains, anxiety, and heart palpitations.
These symptoms match those of alcohol intolerance caused by medication like disulfiram (Antabuse medication) prescribed to individuals with alcohol addiction problems.
Antibiotics like Zyvox, commonly prescribed to treat pneumonia and skin infections, can also result in dangerous interactions when combined with alcohol. Drinks packed with tyramine can cause sudden blood pressure spikes when combines with Zyvox. Other antibiotics like Cycloserine prescribed to individuals with tuberculosis can increase seizure risk drastically.
Combining antibiotics and alcohol can damage your organs. Common tuberculosis treatments like pyrazinamide and Rifadin have a severe effect on the liver. When mixed with alcohol, they can cause liver damage. The potential for organ damage is so serious that individuals who have alcohol addiction history shouldn’t be prescribed these medications. 
Below we have listed the names of antibiotics that you should strictly avoid alcohol while continuing the course of medication. These include:
Alcohol should be avoided when taking antibiotics like tetracyclines like doxycycline and minocycline because doxycycline reduces the effectiveness of antibiotics and minocycline can increase liver disease risks.
Oxazolidinones like Linezolid shouldn't be mixed with alcohol because it can cause fever, agitation, rapid heartbeat, unusual sweating, rapid breathing, vomiting, elevated blood pressure, seizures, abnormal heart rhythm, coma, cardiorespiratory depression, muscle spasms, muscle rigidity, and altered mental status.
Sulfonamides like trimethoprim and sulfamethoxazole shouldn’t be mixed with alcohol to avoid side effects like a folic acid deficiency.
Fluoroquinolones like levofloxacin and ciprofloxacin can cause confusion, nervousness, agitation, memory loss, disorientation, and attention disturbances when mixed with alcohol. The effects are, however, pronounced with high alcohol consumption.
Nitroimidazoles like metronidazole can cause headaches, facial flushing, nausea, vomiting, and abdominal cramping when mixed with alcohol. In fact, you shouldn't take alcohol for 3 days after your last dose of Nitroimidazoles.
While most antibiotics will cause some side effects when taken alongside alcohol, some antibiotics will result in more severe effects than others.
If you take alcohol alongside common antibiotics like Metronidazole (used for treating vaginal and dental infections) or Tinidazole (used to treat similar infections as well as some parasitic infections), you can suffer from severe diarrhoea, vomiting, and nausea. These side effects can cause heart palpitations and dehydration.
Trimethoprim-sulfamethoxazole, Septra or Bactrim can also cause severe nausea and rapid heart rate when taken alongside alcohol. Erythromycin can heighten intoxication due to its tendency to empty the digestive system. Erythromycin can cause lethal alcohol poisoning. Antibiotics like disulfiram can cause intolerable symptoms.
While taking a beer when taking antibiotics won’t kill you, it can cause unpleasant side effects. Excessive consumption of alcohol alongside antibiotics can result in severe side effects that can lead to serious complications and death.
Skipping a dose of antibiotics to drink alcohol affects the effectiveness of antibiotics. Treatment can fail if you don’t take your antibiotics as prescribed. The bacterial infection may last longer or reoccur, creating a need for a stronger dosage and longer treatment period. There’s also a risk of developing resistance to antibiotics.
Skipping antibiotic dosage to drink can also cause serious withdrawal effects like mood changes, sleep problems, tiredness, headaches, anxiety, and flu-like symptoms.
YES! Alcohol can cause organ damage when taken alongside antibiotics. Without a properly working liver, antibiotics can’t be broken down. Alcohol is metabolized in the liver by ADH (alcohol dehydrogenase). If a person ingests a lot of alcohol when they are taking antibiotics, the work of ADH can be inhibited.
Drinking alcohol may not hinder the work of antibiotics in most cases. However, it can interfere with healing in many ways. To recover from an infection or sickness, a person needs adequate amounts of rest and a nutritious diet. Alcohol makes it impossible to rest adequately and maintain a balanced diet.
Alcohol disrupts sleeping patterns. Contrary to popular belief, alcohol doesn’t improve sleep. In fact, alcohol reduces REM sleep.  Alcohol prevents the body from absorbing nutrients. Alcohol also increases energy levels.
All these factors make it hard to sleep. They also reduce the body’s ability to fight infection. Acute alcohol usage or binge drinking is harmful, whether a person is taking antibiotics or not.
Important: Alcohol is present in many products besides typical alcoholic beverages like wine and beer. Alcohol is also present in some cold medication, mouthwash, and foods such as cakes.
The importance of checking everything you use or eat can’t be overlooked, especially when you are taking antibiotics. What’s more, since antibiotics are only prescribed for short time periods, you can do without products or foods with alcohol when taking antibiotics.
The type of antibiotics a patient is taking will dictate how long they should wait before drinking alcohol. Different antibiotics have varying side effects when mixed with alcohol. Some antibiotics offer specific timeframes when a person should avoid alcohol.
Metronidazole manufacturers advise patients to wait for 48 hours (after taking the last dose) before they can resume alcohol consumption. This recommendation is in line with the time it takes for metronidazole to leave the body of an adult.  It may be advisable to take more time i.e., allow an extra day just to be sure or when taking other antibiotics like Tinidazole, which can take longer in the body.
When taking other antibiotics that may not have specific guidelines on alcohol consumption after completing dosage, ask your doctor.
The NHS, among other global health organizations, is attempting to reduce antibiotic usage since overuse has reduced the effectiveness of antibiotics in general (resulting in antibiotic resistance). There is an emergence of ‘superbugs’ causing death globally. 
Some antibiotics are putting patients in harm’s way. The importance of finishing prescribed antibiotic dosage can’t be overlooked even if a patient feels better.
Some strains of bacteria are already resistant to many antibiotics making treatment more challenging. Bacteria like MRSA, clostridium, and the bacteria that cause drug-resistant tuberculosis are already resistant to many antibiotics. 
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