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A man who has been at the local tavern, drinking alcohol heavily, is assaulted. He is transported to the hospital. Among various findings is an infection for which prompt antibiotics treatment is indicated. Given his high blood alcohol level, which of the following antibiotics should be avoided?

A. Amoxicillin
B. Cefoperazone
C. Erythromycin ethylsuccinate
D. Linezolid
E. Penicillin G
 

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A man who has been at the local tavern, drinking alcohol heavily, is assaulted. He is transported to the hospital. Among various findings is an infection for which prompt antibiotics treatment is indicated. Given his high blood alcohol level, which of the following antibiotics should be avoided?

A. Amoxicillin
B. Cefoperazone
C. Erythromycin ethylsuccinate
D. Linezolid
E. Penicillin G
B. Cefoperazone is the answer due to disulfiram like reaction !
 

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there are five drugs which can produce DISULFIRAM like reaction when taken with Alcohol
METRONIDAZOLE
CEFOPERAZONE
CEFAMANDOLE
CEFOTETAN
CHLORPROPAMIDE

answer should be cefoperazone.
 

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C. Erythromycin could also be the answer :notsure: Since it is metabolized by cyt P450, in acute alcohol intake, this system is already involved in alcohol metabolism, so erythromycin's metabolism decreases, its blood level increases, potentially enhansing the risk for QT prolongation, ventricular arrythmias and sudden cardiac death. Erythromycin also increases gastric motility, futher increasing alcohol absorbion and its levels in blood.
 

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C. Erythromycin could also be the answer :notsure: Since it is metabolized by cyt P450, in acute alcohol intake, this system is already involved in alcohol metabolism, so erythromycin's metabolism decreases, its blood level increases, potentially enhansing the risk for QT prolongation, ventricular arrythmias and sudden cardiac death. Erythromycin also increases gastric motility, futher increasing alcohol absorbion and its levels in blood.
Although I agree with your other points (I myself was going to answer Erythro, but I guess I was wrong).

I dont know about this one:

"Erythromycin also increases gastric motility, futher increasing alcohol absorbion and its levels in blood."

Increased gastric motility will lead to increased peristalsis, and increased clearance from the stomach into small intestine. Alcohol is mainly absorbed in the stomach, so it would effectively decrease the amount that is absorbed.
 

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It seems that most alcohol absorbtion occurs in the small intestine rather than the stomach, and its rate of absorbtion depends on gastric emptying. Erythromycin increases gastric peristalsis but decreases small intestinal transit, though increasing BAL. I know that Kaplan gives a different answer, and not sure, it seems correct in conditions of an empty stomach, and I think that is what USMLE tests.
 

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It seems that most alcohol absorbtion occurs in the small intestine rather than the stomach, and its rate of absorbtion depends on gastric emptying. Erythromycin increases gastric peristalsis but decreases small intestinal transit, though increasing BAL. I know that Kaplan gives a different answer, and not sure, it seems correct in conditions of an empty stomach, and I think that is what USMLE tests.
I guess we have to pick the best choice, that was one of the cephalosporin drugs. :rolleyes:
 
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