Antibiotics include a wide range of medications with many metabolic pathways for the treatment of bacterial infections. A 2020 systematic review evaluated alcohol interactions with common antibiotics, highlighting risks such as reduced drug efficacy, liver toxicity, and disulfiram-like reactions (285). Studies have found that ethanol coadministration with erythromycin, a CYP3A4 substrate, and inhibitor, increases the drug’s lag time by 136% while decreasing Cmax by 15% and AUC by 27%, suggesting significant impacts on absorption (286, 287). Other antibiotics like isoniazid and rifampin carry a heightened risk of hepatotoxicity when combined with alcohol (285). Isoniazid is metabolized by N-acetyltransferase 2 (NAT2) and can inhibit CYP3A4 while inducing CYP2E1, although does not appear to have a pharmacokinetic interaction with ethanol (0.73 g/kg) (288, 289). Other common antibiotics, including ceftriaxone and trimethoprim-sulfamethoxazole, are associated with disulfiram-like reactions, producing symptoms such as flushing, nausea, and tachycardia (285). While consuming alcohol with antibiotics appears to carry great risks, evidence of alcohol’s impact on antibiotic pharmacokinetics remains inconsistent.
