Warning: Metromidazole

[Joey Boy]

After going to Bumrungrad and seeing the 3hr wait in the Ear.nose,throat center I went to the ER opposite to be told they wouldnt treat me as it wasnt an emergency and to go back to ENT center..

Fvcked that idea off pretty sharpish and went looking for a medical center, stumbled upon one soon enough and after a quick examination (which included the doctor asking me if I drank alcohol) I was told I had an ear infection.

5 minutes later I was walking out of the door with the usual 5 different sorts of pills + some ear drops.. 2 sorts of antibiotics / 2 sorts of pain killer, and some anti inflamotorys.

One of the antibiotics I have identifyed as Metromidazole, which is the absolute most dangerous antibiotic you can possibly take and then drink alcohol (and from what i've read online shouldnt have even been prescribed for an ear infection). The tw@t never even told me not to have a beer, never mind that the side effects if I did included: Flushing, fast heartbeats, nausea, vomiting, dizziness, loss of coordination, numbness and tingling, and seizures.

Cheers Doc

[Sheryl]

Not an uncommon experience for a small private clinic in Thailand. Multiple prescriptions, including unnecessary drugs and often inappropriate ones, are typical.

There's a reason people pay more to be seen at the better hospitals. But next time, make an appointment!

And there is more to choose from than Bummers. Samitivej and BH are of equali caliber and less crowded. BNH is of equal quality but slightly smaller range of services, also less crowded. Phayathai and Chao Phyra Hospitals are acceptable to good quality, frequented by middle class Thais, less crowded and much less expensive. Being smaller, they are also a lot friendlier, and while they don't have as many English speakers on staff you can specify an English speaking doctor when you make an appointment. These two do not have the full range of specialists that Bummers, Samitivej etc have, but fine for general medical, ENT and the like.

[bina]

i have yet to meet any thai (from the working guys , poor uneducated etc) that DO NOT know to not drink; i.e. when i take them to a doctor and they are given meds, they always say , no drinking, chai mai?? .... its a given....

[repoulin]

Bumrungrad Hospital has a great PR and big budget, but unfortunately I think they are over-rated. Fantastic hospital with international translators and a patient database system sponsored by Intel. But the Mc Donalds throws it off, and after visiting the majority of hospitals in Bangkok, I have found many others that blow Bumrungrad away and offer much more affordable pricing.

-Rich

[Joey Boy]

i have yet to meet any thai (from the working guys , poor uneducated etc) that DO NOT know to not drink; i.e. when i take them to a doctor and they are given meds, they always say , no drinking, chai mai?? .... its a given....

Uneducated sounds about right, with almost all penicilins you can have a have drink while taking them.. No problemo

Theres just a select 2 or 3 which can severly fuk u up

[bina]

when taking most antibiotics etc drinking does change the absorbtion level in your stomach, including vitimin absorbtion etc ; drinking milk for many types of anti's also.... but medication and alcohol, always a big NO NO......

[Joey Boy]

A widespread myth holds that you shouldn't drink alcohol while taking antibiotics, but in fact, drinking doesn't lessen the effects of the drugs. However, alcohol can lower your general energy and delay your recovery so it is best to minimize drinking until you've finished the prescribed course of antibiotic treatment. (Beyond that, chronic liver damage from excessive alcohol consumption can affect the metabolism and toxicity of antibiotics.)

Andrew Weil, M.D

www.drweil.com

antibiotics and alcohol consumption

There is a generally held belief that alcohol should not be consumed while on a course of oral antibiotics. This advice is correct if a patient is taking metronidazole, cephamandole (may cause a disulfiram-like reaction), and possibly oral ketoconazole (may cause facial flushing). However there is no contraindication to the consumption of alcohol with other antibiotics.

www.gpnotebook.co.uk

Is it safe to drink booxe when taking antibiotics?

It's one of the great myths that mixing antibiotics with alcohol can seriously mess you up. While it's unwise to mix medicine with liquor, few drugs are affected by the action of pints. The way it works is this...

www.menshealth.co.uk

Those are quotes from the top 3 hits on google when searching for "antibiotics and alcohol".

[Prakanong2005]

when taking most antibiotics etc drinking does change the absorbtion level in your stomach, including vitimin absorbtion etc ; drinking milk for many types of anti's also.... but medication and alcohol, always a big NO NO......

but medication and alcohol, always a big NO NO......

Sorry that is just plain wrong - yes there are *Some* medication where one should not drink either due to the adverse effects or the effifacy is lessened but there are many more where you can drink - it should be in moderation of course as always.

I have worked in Clinical Trials for a number of years and the protocol does not always have as an exclusion factor alcohol consumption which it surely would if this was a factor

The labeling on any medication (that white piece usually inside the packet that most discard) would always indiacte if no alcohol was to be taken and it would err on the side of safety.

Joey is correct about the myth of anti-biotics and alcohol but then again your uneducated Thai's must know more about pharmacology than the Medical Directors I work with

[Crushdepth]

and after visiting the majority of hospitals in Bangkok, I have found many others that blow Bumrungrad away and offer much more affordable pricing

Well why don't you tell us!

Personally I thought Bumrungrad was great and haven't had to wait more than 20 minutes. Anyway the waiting time to see a specialist in Australia is often around 3 *months*...

[wave]

I wouldn't necessarily put your adverse reaction down to the mixing of metronidazole and alcohol. I have been prescribed metronidazole on a couple of occasions. Once from a dentist for a gum infection and once in Thailand for an ear infection as well. Both times I have felt absolutely awful, similar to how you described. I didn't mix the metronidazole with alcohol, they are quite capable of making your feel like that all on there own!

I was told by my dentist that it is an extremely hardcore antibiotic that strips ALL bacteria from your system and feeling like this is not uncommon. I guess mixing with a couple of pints doesn't help! That said I just couldn't finish the whole course of these buggers! I think I lasted about three days...

I presume the prescribing of metronidazole is a kind of "if that doesn't sort the infection out nothing will" approach, I tend think it is more a case of "over egging the pudding"!

[Totster]

After going to Bumrungrad and seeing the 3hr wait in the Ear.nose,throat center I went to the ER opposite to be told they wouldnt treat me as it wasnt an emergency and to go back to ENT center..

Fvcked that idea off pretty sharpish and went looking for a medical center, stumbled upon one soon enough and after a quick examination (which included the doctor asking me if I drank alcohol) I was told I had an ear infection.

5 minutes later I was walking out of the door with the usual 5 different sorts of pills + some ear drops.. 2 sorts of antibiotics / 2 sorts of pain killer, and some anti inflamotorys.

One of the antibiotics I have identifyed as Metromidazole, which is the absolute most dangerous antibiotic you can possibly take and then drink alcohol (and from what i've read online shouldnt have even been prescribed for an ear infection). The tw@t never even told me not to have a beer, never mind that the side effects if I did included: Flushing, fast heartbeats, nausea, vomiting, dizziness, loss of coordination, numbness and tingling, and seizures.

Cheers Doc

If I have to visit a doctor or get meds from a chemist I ALWAYS ASK them what the meds are called, and whether it's safe to drink when taking them. I also make sure it won't affect my Asthma or react with any other medication I may be taking.

Yes you can blame the Doctor, but this is not the same as in other countries, look after yourself, be sensible and ASK.

totster

[Prakanong2005]

Totster

Good advice - the Pharmacist should know more than the Dr actually about the pharmacology of the medicine and how it reacts withing the body together with adverse effects with other medicines and booze

[Sheryl]

As noted, it is not the case that alcohol is contraindicated for all antibiotics.

it IS contraindicated for metro, not because it impairs the efficacy but because it greatly exacerbates adverse reactions such as nausea/vomiting. Which can happen in the absence of alcohol, but is much worse if you drink.

And yes, it is true that pharmacists -- actual pharmacists -- are the best source of info like this...but few pharmacies in Thailand are sctually staffed by one.

Nurses are also a good source of info, often better than docs (disclosure: I am one, so there's a bias here..but I can't begin to count how many adverse drug reactions and diseases related to the effects of medications I have identified that the diocs missed. Don't know why, they just don't seem to give the matter much attention...)

[Prakanong2005]

"but few pharmacies in Thailand are sctually staffed by one."

Good point - they are often junior Dr's working extra on a lot of pharmacies to earn a few extra THB.

There are a few I have found with Pharmacists though and they have been quite good - Booys always have a Pharmacist on hand.

I have found when I have contacted our office in BKK for personal advice they have always referred the question to the Pharmacist or Country Medical Director which means I am getting the best advice available from there.

[Joey Boy]

I wouldn't necessarily put your adverse reaction down to the mixing of metronidazole and alcohol. I have been prescribed metronidazole on a couple of occasions. Once from a dentist for a gum infection and once in Thailand for an ear infection as well. Both times I have felt absolutely awful, similar to how you described. I didn't mix the metronidazole with alcohol, they are quite capable of making your feel like that all on there own!

I was told by my dentist that it is an extremely hardcore antibiotic that strips ALL bacteria from your system and feeling like this is not uncommon. I guess mixing with a couple of pints doesn't help! That said I just couldn't finish the whole course of these buggers! I think I lasted about three days...

I presume the prescribing of metronidazole is a kind of "if that doesn't sort the infection out nothing will" approach, I tend think it is more a case of "over egging the pudding"!

Those side effects were cut and pasted from the internet luckly, I didnt bother taking the Metromidazole after what I read, only the dicloxacillin which has cleared the infection up nicely

I forgot to mention, he was wanting to give me penicilin injection in my ear aswell

Talk about over medication!

[Heng]

IMO it's a good idea to get a second opinion when you encounter a drug you're not familiar with (especially when the doctor himself/herself doesn't know much about you either other than what you tell them in a 5 minute survey). It's your body.

Personally, we use metronidazole to treat sick pet fish and when we do... in a breeding pen or tank of 1000 fish, that'll cure about 800 of them and kill 200 of them if we're lucky.

[bina]

flagyl is used for treatment of jiardia (stomach parasite) and several female complaints (tricho, etc).... it works

[katana]

Personally, we use metronidazole to treat sick pet fish and when we do... in a breeding pen or tank of 1000 fish, that'll cure about 800 of them and kill 200 of them if we're lucky.

er...maybe it was the fact that they were sick that 20% died... (not sure if you meant the antibiotic killed them?).

[Sheryl]

Metro (flagyl) is indeed effective for giardia and also trichimonas (a type of vaginities). There is an equally effective drug called tinidazole that works for these same conditions and is nowadays more often presecribed as it is better tolerated (in terms of side effects) and requires a shorter course of treatment. But flagyl will also work, and isn't likely to kill anyone unless they are allergic to it. However, it is not a normal choice in traeting otitis (ear infection) and would only be used if there was reason to think the infection was due to an unusual organism -- which one wouldn't even consider unless more usual drugs had been tried and failed.

OP -- I trust you mean the doc wanted to give you a penicillin shot FOR your ear rather than IN it?? Because otherwise, you were truly in the hands of quack....

[Joey Boy]

Sheryl, If I remember correctly he said injection in your ear, which is why I wasnt to keen on the idea..

The course of dicloxacillin he gave me only lasted 3 days, and the infection re-occured as soon as I stoped taking it. So I ended up @ Bangkok Hospital, which incidently only had a 5 minute wait. The doc there gave me levofloxacin which u only have to take 1 pill of per day of.

Expensive pills tho, 1'200 baht for 5 of the bad boyz

[Sheryl]

Sheryl, If I remember correctly he said injection in your ear, which is why I wasnt to keen on the idea..

The course of dicloxacillin he gave me only lasted 3 days, and the infection re-occured as soon as I stoped taking it. So I ended up @ Bangkok Hospital, which incidently only had a 5 minute wait. The doc there gave me levofloxacin which u only have to take 1 pill of per day of.

Expensive pills tho, 1'200 baht for 5 of the bad boyz

Quack, quack, quack-quack.....!!

Actually, I regret to say that it possible this guy has an MD, there are docs in Thailand who practice like this. (Although if he really was going to inject INTO your ear then I'd have to go with true, unlicensed quack in the full sense of the word).

The proper course of treatment would be 7 - 10 days. As a general rule of thumb, with few exceptions (like single long-acting doeses) an antibiotic should be taken for a minimum of 5 days, preferrably 7-10. The problem with a 3 day course is that it kills of some but not all of the organisms, and those that survive become resistant. Hence the need now for a more expensive drug. Chances are, if you'd been given a full 10 days of the doxycline in the first place , that would have done it.

Anyhow you're in good hands now, be sure to finish the full course of the meds (don;t stop even if you feel better). Good luck.

For future reference -- and assuming we're talking about a simple inner ear infection (symptom being earache but no drainage or obvious inflammation on the outside of the ear or around the jaw), the usual firstline treatment is either Bactrim (double strength, one, twice a day) or amoxicillin (500 mg three times a day), both cheap and readily available over the counter. Should be taken for a full 7-10 days. And if no improvement in the pain after 3 days, stop self-treatment and consult a doctor. (Or else consult a doc from the onset -- but not a small private clinic quack)

BTW -- the Cambodian word for doctor or nurse is "bet" same as the Thai word for duck. Always cracks me up to hear patients summoning the doctor "Bet, bet..." conjuring up images of ducks with stethoscopes round their necks, waddling and quacking. (Alas, in the case of Cambodia, the duck/quack analagy is more often than not an apt one!!)