Post #29 put the caveat in the right place and I want to underline it.
Reading this Antibiotics thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not.
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Practice · Interactions · continued
[2026 update] Antibiotics and a course of something with delayed emptying posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Delayed gastric emptying is the mechanism behind most of the plausible interactions in this class: anything whose absorption depends on how quickly the stomach empties can behave differently.
None of the above is medical advice and I am not qualified to give any.
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a.nwosu, post #6: Where I part company with post #5, and it is a narrow parting. The failure mode on Antibiotics is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong. Go to post
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
If anyone can point at the primary source I would be grateful.
m.ramos, post #18: Narrowing post #16, because the general version has more than one answer. Whatever the answer on Antibiotics turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction. Go to post
I have been on both sides of the Antibiotics argument in this category within eighteen months, which should tell you how strong the evidence for either side is.
Marking my place. If it changes for me I will come back and say so.
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Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer.
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k.salinas, post #25: I will take the caveat as seriously as the claim, which is the point of putting it there. Go to post
The reason Antibiotics is hard to answer is that the obvious measurement and the relevant quantity are not the same thing, and substituting one for the other is silent.
Picking up post #39: that is the part I would want checked first.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
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Collapsed as off-topic by two members at trust level 3 or above
On post #40 — agreed on the reasoning, with one qualification.
Checked the Antibiotics claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.
s.karlsen_rph, post #22: Reporting rather than recommending, on Antibiotics. What happened is above. Whether it should have is a different question and not one I am qualified to answer. Go to post
Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.
Worth checking against a second source before it gets quoted onward.
What I can speak to on Antibiotics is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know.
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Post #44 describes the usual case. This is about the unusual one.
Alcohol is not contraindicated in the labelling and it does irritate a stomach that is already emptying slowly. There is no published interaction study, and the conservative reading is the obvious one.
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Confirming post #46 from a second method, which matters more than confirming it from a second person.
Since Antibiotics keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it.
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j.habermann, post #19: On post #16 — agreed on the reasoning, with one qualification. Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer. I am aware this is the third time this month I have made this point. Go to post
The most useful reply I ever got about Antibiotics was a request to state my units. It sounds like pedantry and it has saved me twice.
j.palacios, post #45: What I can speak to on Antibiotics is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know. Go to post
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
Anyone with a larger sample, please post it.
Antibiotics is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.
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r.restrepo, post #30: I read post #26 twice before replying, because I had assumed the opposite. A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better. Go to post
On post #47 — agreed on the reasoning, with one qualification.
Before the thread moves on from Antibiotics — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
j.habermann, post #19: On post #16 — agreed on the reasoning, with one qualification. Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer. I am aware this is the third time this month I have made this point. Go to post
Picking up post #51: that is the part I would want checked first.
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
I keep a log for Antibiotics specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.
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Collapsed as off-topic by two members at trust level 3 or above
Nothing to add on the substance. Thank you for taking the question at face value.
Post #51 describes the usual case. This is about the unusual one.
Antibiotics is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.
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f.sjoberg, post #27: Taking post #24 at face value and following it one step further. The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap. Go to post
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
I disagree with the framing of Antibiotics above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.
The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.
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Source for the Antibiotics figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
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p.novak, post #47: Confirming post #46 from a second method, which matters more than confirming it from a second person. Since Antibiotics keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it. Go to post
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
I would rather say I do not know than round it up to an answer.
Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.
The conclusion is tentative; the arithmetic underneath it is not.
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