• Kaelyn Turner

There's an oil for that.

Oh boy Mickey Mouse. It's been a hot minute.


Me life has been eventful.

We were in a wedding. Then went on a small vacation. Husband got a new job, went to Aaron Rogers country twice. Iiiiiiii re-got COVID and so did my husband and baby. COVID in a 7 month old was SKETCHY. If not for my ER nurse background we 100% would have ended up in ER due to dehydration in the baby.


Yes that's my own horn and yes I am tooting it. Then the following week I got some wicked bad food poisoning. Holy shit. I still have PTSD. Then I had a surgery I been wanting to have x years. On my face. Still not recovered from that.


Working on a certification for a career move.


It's so damn aggravating when people talk about how busy they are. Like. Stop. Everybody has busyness. It's gross. Be cool.


There's no patch in boy-scouts for having the most busyness to do.

K.


I still have a list of topics going but one occurred to me while recovering from this surgery I paid somebody to do to me. And HOW I never thought to address this issue before? The way I love wine.... I dunno. Well. Maybe I do know.

I haven't taken an antibiotic for any reason in -I think- 4-5 years?


I had Bronchitis soooo bad the semester I was graduating NP school or maybe the one before that, and I resorted to "A ZPack" on day 8 of illness, and that was in Spring 2018 or Fall 2017...

Soooooooooo then fast forward to now, and I got a damn fricken sonofa post-op infection.

*foot stomp*
Right foot let's stomp.
Left foot let's stomp. Hands on ya knees hands on ya knees.
Two hops this time!

Me. Psycho me. I got a post-op infection. My assumption is that it's because I'm a nasty former-ER rat turned Urgent Care mouse and my body just houses these germs and 1 of them slimy sonofa's found an opportunity to try and kill me. That's dramatic, not kill me but.

You know what I mean.


So. Then here I am... a week sober, because I WAS being such a good patient. [Y'all. Not an alcoholic, "this is a dramatization."] And not only do I have to take MORE antibiotics when the standard ones didn't suffice, but I'm AGGRAVATED. Looking at 2 weeks total on antibiotics. Ugggghhhhhhhhhhhh.

Rawr on my keyboard.


Soooooooooo now that the bleeding risk was way far behind me from surgery... Taking my vitamins and meds and drowning in water and coconut water and coffee and whatever... I finally felt ready for wine. But I was now prescribed Levaquin...


Which leads to one of the most common questions we get when prescribing antibiotics...

Is it true that I can't drink while I'm on it?

The answer is, knee jerk, that is true, no you can't. If you're sick enough to need an antibiotic, you're too sick to drink. Key word: knee jerk.


It's two words.


K.


But are you really not supposed to? Not always. So, the actual answer is - it depends.

"It depends" is why we still need HUMAN doctors and NPs and PAs and Nurses. Because we are humans. And every situation is different. And we are there to help you work through your individual situation. So let's be real, if antibiotics are prescribed for 5-14 days, there's a chance of you having plans (with your couch, TV docuseries, dog, blanket and snack), and also wanting to do the right thing/be safe/not screw yourself up.


Soooooooo, can I drink while on antibiotics?

(The way I typed it at first was "Can I drink on antibiotics?" And I think that's a Southern thing?? But that's how everybody asks the question here, but when I added "while"...I realized, hm, that's probably the right way to grammar, bumpkin.)


The #1 answer of all time - ask YOUR provider about YOUR situation and YOUR medication.


This blog is 100% not medical advice, if you choose to drink alcohol while you're on antibiotics and something bad happens to you - you made that choice. I'm just talking about it like we at the bar at the Italian restaurant, people-watching, eating hummus and sipping some chilled sauv blanc at lunch time.



Times to definitely NOT consume alcohol while on Antibiotics:

  1. You have fever. What is fever? An oral temperature of 100.4 or higher.

  2. You have just had surgery in the last 3-5 days.

  3. You are going to have surgery in the next 3-5 days.

  4. You are in the hospital.

  5. You aren't in the hospital but you should be.

  6. You are taking narcotic pain medication with your antibiotics.

  7. You are taking antibiotics for a MAJOR infection of one of your organs - such as Pneumonia.

  8. Any time. Because if you are sick, and you feel bad enough to take an antibiotic - you prolly needa chill.

  9. You have a problem limiting your alcohol consumption. Not a drinking problem, a stopping problem...

  10. You have kidney/liver disease.

  11. You have Diabetes.

  12. You are on other medications that could have bad interactions.

  13. You bleed easily or take medications that thin your blood.

  14. You are taking Metronidazole/Flagyl...... sort of...

  15. So many reasons.

Guys. COMMON SENSE. If you are taking preventative antibiotics, like say, for Acne, or for planned dental work, or post-operatively and things are going well/going fine/you're fine/it's been some days...and it's ya best friend's birthday and y'all wanna turn up...it's probably fine.


K! SO... The specific drug you are prescribed matters.


I'll give a short speech about Flagyl in particular because this is the big "no-no" one that personally, I was taught in RN and NP school.

I'd like to take a moment to give a shout out to everybody out there that hates us. Everybody that thinks we are robot monkeys that can't think for ourselves. We are evil healthcare professionals and only ever spit out what they teach us in school.


Story time: Not in the mood for a story? Skip down to the (1)... Anyway, I legit have a "friend" that I went to school with my entire life, who is now a hairdresser (NO shade, I have many intelligent, successful, awesome human friends who are hairdressers...this story is regarding the individual), who would literally be doing my hair and verbally attacking doctors and nurses. This was during the "Anti-Vax" movement a few years back, when it was trendy. I mean she would just rip "us" as a whole to shreds, telling me that we are just like marionettes or string puppets that only practice what we are taught in school. That's ALL we know... what's in our text books and what the professors tell us. LOL. Like as if the information she got from her FB Moms groups and her conspiracy theory dark webs & essentialoilsforheartattack.com were not accessible to us as well. LOL

There's an oil for that.

Let's just say I didn't last long in her chair. Because I asked her well I mean are you coloring

my hair with the juice of blackberries and strawberries because if not, I'm 99% you putting chemicals on people all day every day??? Never went back. Sure as hell not spending my money I earn as a nurse, doing a job she is ignorant about at best, to be told I'm stupid and that I have no one's best interest in mind but big pharma LOLLLLLL. Y'all. Humor.



So, this monkey here, me... I'm here for all the good doctors and nurses. The amount of information guys, that we are required to know in order to function at a bare minimum, is mind blowing. We can't know EVERYTHING, right NOW! It takes years and decades for us to perfect our craft. We learn in real life - JUST like you do. In the course of writing this blog... I learned that what I was taught about Flagyl, isn't so accurate. Remember, nursing schools, NP schools, they are sending us out into the abyss. There are some things that we will encounter very frequently, and they have to drill those blanket recommendation statements into us, so that even if a situation is grey, or the risk isn't the same for all people with a given treatment/medication... they want us to robotically respond with the safest answer... This is in the interest of PUBLIC HEALTH! Just like I demonstrate in this blog, we are capable of learning more, refining our knowledge/skills/recommendations, and sharing it with you!

End story time.

Ahem.

(1) Metronidazole (metro-ni-duh-zole) aka "Flagyl" - is an antibiotic, that is super commonly prescribed, at least in my world... For Bacterial Vaginosis ("it's not an STD it's a pH imbalance in the vagina") and for Trichomoniasis (an STD). In the Gastrointestinal world - it's used to treat "H. Pylori" infections in the stomach. This medication is usually prescribed for anywhere from 1 day to 14 days depending on what you're treating. This medication is metabolized (broken down into its tiny chemical particles after it is digested) primarily in your LIVER. As many things are. But this one has a reputation for causing "violent illness" (vomiting) when combined with alcohol. As it turns out... the "evidence" - meaning research/scientific evidence - for this reputation is weak.


Hang on we gonna turn on 2 wheels for a second...





The "violent illness" that we were all ROBOTICALLY (eye roll) taught is what is known as a Disulfiram reaction (di-sul-feer-um). To be concise: "Data are controversial regarding risk of a disulfiram-like reaction" with Metronidazole. (2) Meaning - it ain't as serious as they scared us into believing. What is a Disulfiram Reaction?


First, Disulfiram is a drug. A pill. The other name for it is "Antabuse". Ant meaning anti meaning opposite. Abuse meaning...well, abuse. Antabuse. Given to people who are experiencing alcoholism, to try to get them to have a negative experience after drinking alcohol. So, a disulfiram reaction, is the negative side effects, typically on purpose, in order to change a behavior (drinking too much). What are the side effects? (3) "At therapeutic doses of disulfiram, alcohol consumption results in increased serum acetaldehyde, causing diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and tachycardia."

So: sweating, heart fluttering, red-hot face, nausea, spinning, low blood pressure, increased heart rate." Ya feeling bad bad.


Another source says, "Disulfiram is used to treat chronic alcoholism. It causes unpleasant effects when even small amounts of alcohol are consumed. These effects include flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety. These effects begin about 10 minutes after alcohol enters the body and last for 1 hour or more. Disulfiram is not a cure for alcoholism, but discourages drinking." (4)


So. This is what they taught us to tell people when we were either giving education as nurses, or when we prescribe as nurse practitioners. But, this source, this summary article, this other literature review all found the same conclusion. Disulfiram reaction, when a patient takes Flagyl and drinks alcohol... isn't really a thing. It can be a thing, because of the way Flagyl affects the liver's enzymes/enzyme activity, but it's few and far between. (5) (6) (7)


Fam, am I saying this is good for you?

Noooo bruh lol I'm saying that it's very unlikely that your average-slice-of-bread-healthy human on no or minimal daily medications with no real health problems is going to experience something really bad if they drink on...while on...an antibiotic. The exciting part is, you never know if it'll be you! HA! Few and far between, is still a few, and I ain't trying to have a Disulfiram reaction.


Moving on.


This source is a alpha to omega, top to bottom, beginning to end summary all in 1 spot, touching on each antibiotic class and some specific drugs. (2) This is another source that breaks it down by drug class. (8)


By drug class I mean... there are multiple medications that are all the same "kind" of drug. Like, theres Jif. And then there's smooth, crunchy, natural, honey...

The category of drug is antibiotic/antimicrobial. That would be "peanut butter."

Then there's a bunch of different kinds. Jif, Skippy, 365, Kirkland, Peter Pan, Smuckers. That would be the drug classes: penicillins, cephalosporins, fluoroquinolones, etc...

The drug class is Jif.

And the individual drugs within a class are smooth, crunchy, natural, natural crunchy, honey. This would be penicillin, amoxicillin, amoxcillin-clavulanic acid, piperacillin, etc...

Make sense? No? Yes?


Soooooooooooo. I ain't gonna go through class by class much less drug by drug to tell you which antibiotics are okay to have a drink or two with. Y'all don't pay me to do this. That's why I provide the sources I use. For you to click.

But, how do you know which class your drug is in if you use my sources???


Well. It's 2022. You don't have to. But - Let's use the ones I've been on in the last 2 weeks. Cephalexin and Levofloxacin.

AKA Keflex and Levaquin.


You can use the sources I provided, (2) and (8).

Source (2) American Society of Microbiology.

(8) The government (eye roll) National Library of Medicine. It's a good source whether you mad at it or not.

Or you can use the other sources I like, such as Medscape and Healthline.


Fam, your ".org" ".gov" sources are usually your best bet. My 2 favorite ".com" sources are Medscape and Healthline. 10/10 recommend putting the Medscape app on your phone, and typing in your healthcare related questions there first.


K. Let's say you're taking Keflex, or Cephalexin. How do you "google it" to see if it's okay to drink at your sister's wedding Saturday night? Y'all were at her bachelorette party last weekend and you got bit by a spider hiding under the bench at the AirBNB in Austin. Now you have this spider bite cellulitis you're dealing with and it shows in your bridesmaid dress.

You type into google "can i drink on cephalexin?" Because it says cephalexin on your Rx bottle, not Keflex.


The first page of Google results (actual results, when I do this myself) are from "nhs.uk", "medicalnewstoday.com", "healthline", "khealth", "therecoveryvillage", "alcoholrehabhelp.org", "www.wise-geek.com", "nytimes.com", "mayoclinic".....


When I see this line up, I will consider information from nhs.uk , Healthline and Mayo Clinic. I'm not even clicking any of the other sites. They are random, not well known, not associated with any type of professional organization, the government, a hospital or a university.

Let's go Healthline. (9)

clap clap clapclapclap


In the first paragraph of this article, it states "Cephalexin is an antibiotic. It belongs to a group of antibiotics called cephalosporin antibiotics, which treat different types of bacterial infections... This drug does not interact with alcohol, but some of its side effects are similar to the effects of alcohol. Also, alcohol may interfere with your infection itself."

Boom. You get a quick answer in the first paragraph. I ALWAYS want you to read the WHOLE article. The side effects that are likely to occur may be off-putting enough for you to refrain from your wine. The key takeaway - the drug does not interfere with alcohol. Meaning, you're fine. The medication will still work, but you may need to CHILL. Like - step away from the shots at the bar after the reception. Have a water, would ya? A meat pie or 2. Wedding meat pies are the best meat pies.


What you want to know is - will drinking decrease the effectiveness of your antibiotic, or will drinking alcohol while on an antibiotic cause harm to you? Those are the 2 questions.


Sometimes... When you nerd out... You find pleasant little surprises. Happy little accidents. RIP Bob Ross.


I just so happen to be taking Levaquin. Soooo by the time it was determined I needed this medication, I really missed wine. Just a little.


Check it out:

"Levofloxacin, moxifloxacin, and trovafloxacin had improved efficacy in alcohol-fed rats compared to alcohol-free rats (24). All antibiotics were equally effective at improving survival and had improved efficacy in alcohol-fed rats." (2)

Y'all. LOOOOLLLLLLLL. Imagine my surprise when I was so fricken distressed and as we say in South Louisiana - "haunte" - that I had a post op infection. Only to find that I can not only have wine, but it might just give my Levaquin superpowers. LOL.


This was a very long story.


The sources are linked below.

Medscape/Medscape App.

Healthline.


I do not care what CVS/Walgreens/Rite-Aid recommend lol There are charts with their company recommendations regarding alcohol and antibiotics. I care about what real research says.


Side note. There are people out there who are clinically dependent on alcohol. Suddenly stopping alcohol consumption in a person who drinks alcohol all day every day can be deadly. It would be UNSAFE in this circumstance to tell a patient to stop drinking cold. They could literally die. As prescribers, it's OUR responsibility to sort out the details on a case by case basis. We might not know in the snap of a finger, but if we tell you "I'm not too sure, but I'll look it up and find out for you today".... You got a good one, beb.


The end, time to sip red wine and watch Young Sheldon.


(1) https://reference.medscape.com/drug/flagyl-metronidazole-342566#5

(2) https://journals.asm.org/doi/full/10.1128/AAC.02167-19

(3) https://www.ncbi.nlm.nih.gov/books/NBK459340/

(4) https://medlineplus.gov/druginfo/meds/a682602.html

(5) https://pubmed.ncbi.nlm.nih.gov/12022894/

(6) https://www.medscape.com/viewarticle/917065_2

(7) https://journals.sagepub.com/doi/10.1345/aph.19118

(8) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038249/

(9) https://www.healthline.com/health/infection/cephalexin-alcohol




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