ALCOHOL-ANTIBACTERIAL DRUG INTERACTIONS: COMPARISON OF THREE DRUG COMPENDIA

Teresa Lançaa, Deolinda Auxteroa,b, Isabel Margarida Costaa,b, Mara Pereira Guerreiroa,b,c

a Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugalb Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Monte de Caparica, Portugalc Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal

Corresponding author: mara.guerreiro@sapo.pt

REFERENCES1. Thomas R. Fulda et al. Curr Ther Res 2000 61(8):540-5482. Chao, S.D.; Maibach, H.I. Am J Clin Dermatol. 2005;6(2):105-11.3. Vitry, A.I. Br J Clin Pharmacol. 2007 Jun;63(6):709-144. Nikolić, B.S. and Ilić, M.S. Bosn J Basic Med Sci. 2013 Nov;13(4):253-8.5. Ekstein, D. et al. Epilepsy Behav. 2015 Mar;44:218-246. Ayvaz, S. et al. J Biomed Inform. 2015 Jun;55:206-177. Hansten, P. D. & Horn, J. R. (2013). Drug Interactions Analysis and

Management. (8th Ed.). Facts and Comparisons.8. Truven Health Analytics. (2014). Micromedex Solutions. Available:

http://www.micromedexsolutions.com9. Baxter, K. (Ed.). (2010). Stockley’s Drug Interactions (9th ed.). London:

Pharmaceutical Press.

BackgroundDrug/drug interactions and drug/alcoholinteractions may lead to adverse effectsand treatment failure. Health careprofessionals rely on drug interactioncompendia to address these problems,but research on information regardingthe existence of interactions and theirclinical relevance has shown significantdiscrepancies between commonly usedsources.1-6

ObjectiveThe purpose of this work, which is part ofa larger study, is:• To compare information on alcohol-

antibacterial interactions in threedrug compendia;

• To assess the consistency amongthese literature sources;

• To summarise information oninteractions with greaterconcordance.

Study designData on interactions between alcoholand antibacterial drugs were retrievedfrom three standard compendia:• Hansten & Horn’s Drug Interactions

Analysis and Management (2013edition) 7

• Micromedex system (accessed June2014) 8

• Stockley’s Drug Interactions (2010edition) 9

Drugs with an ATC code J01 wereconsidered, plus metronidazole andnitroimidazole-related compounds,which are regularly used in bacterialinfections.

Data on the interaction mechanism,severity and management wereextracted for interactions documented inat least two of these sources.

ResultsStockley’s documented 17 interactionswhile Micromedex and Hansten & Hornlisted seven and six, respectively.Figure 1 depicts the interactions betweenalcohol and antibacterial found in thethree compendia. Only cefamandole,metronidazole and tinidazole hadinteractions listed in all sources.

There was concordance among Stockley’sand Hansten & Horn that ciprofloxacinhas no relevant interaction with alcohol.The remainder drugs interact withalcohol via pharmacokinetic mechanisms.The severity of the interactions isindicated in Hansten & Horn andMicromedex, as shown in Figure 2.Avoiding alcohol consumption was themost common advice for interactionmanagement in all compendia.

Conclusions

• There were discrepancies in theinformation regarding alcohol-antibacterial interactions among thethree compendia;

• Interactions with alcohol seem tooccur with only a limited number ofantibacterial drugs but documentedinteractions have generally clinicalrelevance.

• In the absence of evidence onalcohol-antibacterial interactions, itis of doubtful benefit to advisepatients on antibacterial therapy torestrict the moderate consumptionof alcohol. Pharmacists should bearin mind that this may jeopardizeadherence, contributing to theburden of antibacterial resistance;

• Pharmacists should be aware ofdiscrepancies among druginteraction sources of informationand use more than one source toidentify and manage alcohol-antibacterial interactions in clinicalpractice.

• PharmacokineticInteraction mechanism

• Hansten & Horn: class 3 (minimize risk), except for ciprofloxacin (class 5: “ignore”).

• Micromodex: major for 6 drugs; contraindicated for metronidazole

• Stockley: (no operational classification)

Interactions severity

• Avoiding alcohol consumption Interaction

management

Figure 2. Results obtained for main outcome measures

Figure 1. Interactions between alcohol and antibacterialdrugs retrieved from the three drug compendia

Implications for Clinical Pharmacists

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