Patients should also be advised on alcohol intake with antibiotics. Anecdotally, many members of the public believe they cannot drink any alcohol with all antibiotics and stop courses early because of this. While it is sensible to avoid drinking alcohol when taking medication or feeling unwell, only metronidazole and tinidazole require complete abstinence from alcohol during the course and for 48 hours (metronidazole) and 72 hours (tinidazole) after its completion.   

Alcohol can cause a serious reaction when combined with these medications. Symptoms include breathlessness, headache, chest pain, skin flushing, increased or irregular heartbeat, light-headedness, and nausea and vomiting.

Other antibiotics that alcohol can interact with (and where caution is required) include:

• Co-trimoxazole: similar reaction to that of metronidazole or tinidazole, although this is very rare; alcohol in moderation does not normally cause a problem
• Linezolid: undistilled (fermented) alcoholic drinks such as wine, beer, sherry and lager can interact
• Doxycycline: alcohol intake especially in people with a history of chronic alcohol consumption can reduce the effectiveness of doxycycline
• Erythromycin: alcohol may slightly reduce or delay its effect.

Reflective exercises

• Antibiotic Awareness Week is the third week of November each year. What specific actions will you take to educate customers and patients about antibiotic resistance?
• With your team, look at the table above showing the expected duration of a sore throat, common cold, sinusitis and cough/bronchitis. How would you explain the expected duration to a customer?