Cephalosporin dietary taboos

While taking cephalosporin antibiotics and within 7 days after stopping the drug, it is absolutely forbidden to consume any food or drink containing alcohol, and even avoid large-scale contact with alcohol on the skin (such as alcohol bathing). This is the only taboo that may be fatal.； Most of the other requirements circulated online such as "no seafood, no grapefruit, no spicy food" have no clear evidence-based basis. They are precautions that vary from person to person and do not need to be one-size-fits-all.

Don't think the doctor repeatedly warns you not to drink alcohol every time you have cysts. It's really not alarmist. Two years ago, when I was working in the emergency department, I met a young man in his early 20s who took cefaclor for two days because of tonsillitis. At a weekend gathering with friends, he drank half a can of 3-degree RIO, thinking that the low alcohol content of sparkling wine would be fine. Within half an hour, his face turned red, his chest was so tight that he couldn't breathe, and he vomited twice. When his friend brought him the drink, his heart rate soared to 128. Fortunately, it was delivered early, and I was given some metabolism-stimulating medicine and kept under observation for one night, and then everything was fine. If he drank high-strength liquor, something might have happened. The principle is straightforward and simple: cephalosporin inhibits the enzyme that metabolizes alcohol in the liver, causing the intermediate metabolite of alcohol, acetaldehyde, to accumulate in the body and cannot be excreted. In mild cases, it can cause blushing, panic, and nausea. In severe cases, it can lead to shock or even life-threatening. This is the disulfiram reaction that everyone often hears about.

Many people think that I will be fine if I don’t drink liquor or beer. This is not true. There are so many hidden sources of alcohol that you can’t think of. Needless to say, wine-filled chocolate, drunken crabs and drunken shrimps, glutinous rice dumplings, and even dishes that have just been cooked with cooking wine may have a lot of alcohol left in them. There is also the Huoxiang Zhengqi water that everyone often drinks. The alcohol content can reach 40% to 50%. Last month, I met an aunt who had a cold and took cephalosporin. She drank two bottles of Huoxiang Zhengqi water as usual. She became dizzy and fell downstairs in the community. Fortunately, she didn't hit her head. What’s even more exaggerated is that a parent used alcohol to wipe the body of a feverish child to cool down. The child happened to be taking cephalosporins. As a result, the skin absorbed a small amount of alcohol, and still developed a rash and felt dizzy. This kind of pitfall is really difficult to prevent.

As for how long it will take to stop taking the medicine before I can drink it? Don’t believe the saying “just stop for 3 days”. Everyone’s liver metabolism is different, and the residual time of cephalosporins in the body varies greatly. I met an old man with fatty liver before. He drank one or two white wine on the 5th day after he stopped taking the medicine, but he still developed symptoms of panic and swollen face. He spent half a night in the emergency room for observation before he recovered. To be on the safe side, it is safest to leave it for 7 days. For people with poor liver and kidney function, it is best to extend it for another two or three days. These few sips of wine are really worth it.

In addition to this red line that cannot be touched, many of the other cephalosporin taboos posted on the Internet are actually controversial, and they are even imposed by Zhang Guanli.

For example, many people say that you should not eat seafood when eating cephalosporins. There are always two opinions in clinical practice: one group believes that seafood itself is a highly allergenic food, and cephalosporins also have a certain probability of allergy. If the two are superimposed, the risk of allergy will be higher than usual. If you are allergic, or you are prone to rashes after eating seafood, then it is really best not to touch it.； But the other school of thought is that as long as you usually eat seafood, there is no problem, and eating normally during the period of taking cephalosporin will not cause any additional side effects. I took cephalosporin last time for bacterial infection, and also ate steamed seabass, and nothing happened. It all depends on the individual's constitution, and there is no need to apply it in one size fits all.

There is also the widely circulated saying "Don't eat grapefruit". This actually applies the taboos of other drugs to cephalosporins. The furanocoumarins in grapefruit do inhibit the CYP3A4 metabolic enzyme of the liver and affect the metabolism of antihypertensive drugs and lipid-lowering drugs. However, the metabolic pathways of most cephalosporins do not involve this enzyme at all, so there is almost no interaction. Only a few cephalosporin species will have a slight impact. If you are really worried, just take a few bites less. There is no need to dare not touch one bite.

As for saying you can't eat spicy food, that's even more unjust. Eating cephalosporins has nothing to do with spicy food. If you take cephalosporins because of strep throat or gastroenteritis, eating spicy food will aggravate your own inflammatory symptoms. That is because you should avoid spicy food when you are sick, not because of cephalosporins. If you have a urinary tract infection and take Cephalosporin, and you usually like spicy food, it’s totally fine to take two bites, and you don’t need to set limits for yourself.

When I give patients cephalosporins, in addition to repeatedly telling them about alcohol, I also ask two more questions: Is anyone going to participate in a drinking party recently? Are you allergic to seafood? Are there any problems with liver and kidney function? If there is a problem that cannot be avoided by drinking, I will usually switch to other antibiotics that do not require alcohol taboos, so as to prevent the young men from getting into trouble because of drinking in order to save face.

In fact, to put it bluntly, the taboos about cephalosporins are not as popular as those posted on the Internet. The core is to stick to the "stay away from alcohol". There is really no need to take other things too seriously. If you are really unsure about what you can and cannot eat, asking the doctor who prescribes the medicine is much more effective than searching for rumors online for half a day.