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.

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Key Concepts

1. Metronidazole does not interact with alcohol (ethanol) and does not cause a disulfiram-like reaction.
2. 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.
3. 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.
4. 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.

References

• 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.