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HelixTalk Episode #135 - Top Four Medications Myths: BUSTED!
Date posted: August 24, 2021, 6:00 am
In this episode, we debunk four medication myths that have persisted for decades: metronidazole and alcohol; statins and hepatotoxicity; cidal vs. static antibiotics; and "sulfa" allergies.
- Metronidazole does not interact with alcohol (ethanol) and does not cause a disulfiram-like reaction.
- Statins can cause transient increases in liver function tests; however, these increases are not associated with hepatotoxicity. Routine LFT monitoring is not recommended unless clinically indicated signs or symptoms of liver injury exist.
- The distinction of bactericidal versus bacteriostatic antibiotics is irrelevant. No evidence exists showing that having a bactericidal drug has superior efficacy to a bacteriostatic drug.
- A “sulfa” allergy nearly always means an allergy to Bactrim (sulfamethoxazole-trimethoprim). There are many non-antibiotic sulfonamide-containing medications that do not need to be avoided in patients with a sulfa allergy; however, patients with an allergy to any medication have an increased risk of an allergic reaction to other medication classes.
- Visapää JP, Tillonen JS, Kaihovaara PS, Salaspuro MP. Lack of disulfiram-like reaction with metronidazole and ethanol. Ann Pharmacother. 2002 Jun;36(6):971-4. doi: 10.1345/aph.1A066. PMID: 12022894.
- Bader T. The myth of statin-induced hepatotoxicity. Am J Gastroenterol. 2010 May;105(5):978-80. doi: 10.1038/ajg.2010.102. PMID: 20445507.
- Cohen DE, Anania FA, Chalasani N; National Lipid Association Statin Safety Task Force Liver Expert Panel. An assessment of statin safety by hepatologists. Am J Cardiol. 2006 Apr 17;97(8A):77C-81C. doi: 10.1016/j.amjcard.2005.12.014. Epub 2006 Feb 3. PMID: 16581333.
- Wald-Dickler N, Holtom P, Spellberg B. Busting the Myth of "Static vs Cidal": A Systemic Literature Review. Clin Infect Dis. 2018 Apr 17;66(9):1470-1474. doi: 10.1093/cid/cix1127. PMID: 29293890; PMCID: PMC5905615.
- Nemeth J, Oesch G, Kuster SP. Bacteriostatic versus bactericidal antibiotics for patients with serious bacterial infections: systematic review and meta-analysis. J Antimicrob Chemother. 2015 Feb;70(2):382-95. doi: 10.1093/jac/dku379. Epub 2014 Sep 28. PMID: 25266070.
- Strom BL, Schinnar R, Apter AJ, Margolis DJ, Lautenbach E, Hennessy S, Bilker WB, Pettitt D. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med. 2003 Oct 23;349(17):1628-35. doi: 10.1056/NEJMoa022963. PMID: 14573734.