Lemon juice affects antibiotic use

Antibiotics and milk - ineffective together?

Antibiotics and milk - there is a risk here. How much truth is there around this myth? Find out here what you need to consider when taking antibiotics with milk at the same time.

The essentials in brief:

  • Antibiotics and milk can be combined if the antibiotic active ingredient is not certain fluoroquinolones or tertacyclines.
  • Even small amounts of milk, e.g. milk coffee, can impair the absorption of these antibiotics and thus their effectiveness.
  • If necessary, there should be an interval of 3 hours between milk and antibiotic.

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This is how antibiotics work properly

Antibiotics work by killing pathogens (bactericidal antibiotics) or by inhibiting their growth (bacteriostatic antibiotics). In order for an antibiotic to prevent bacteria from multiplying at the site of infection, a defined concentration of active ingredient is required at the source of the infection. This concentration is known as the minimum inhibitor concentration (MIC).1 It is usually different for each antibiotic.
As long as the MIC at the infection site is exceeded enough, the antibiotic can have maximum effect. These include:

  • Beta-lactam antibiotics (e.g. Cefurax)
  • Vancomycin
  • Clindamycin
  • Macrolides

There are also antibiotic active ingredients that require an active ingredient dosage that is well above the MIC (concentration-dependent antibiotics). This is the only way to achieve their maximum antibacterial effect. Even if the antibiotic is stopped, the effects will remain for some time. These include:

  • Metronidazole
  • Aminoglycosides
  • Fluoroquinolones

When antibiotic treatment is due, it is important that the antibiotic reaches the source of the infection in the right concentration so that it can develop its maximum effect. However, many antibiotics enter into interactions that impair their anti-infectious effectiveness. Among other things, can certain foods affect the effectiveness of an antibiotic.2

Don't combine antibiotics and milk?

The general advice to avoid antibiotics and milk is a myth. The statement is not entirely correct. Because the interaction between antibiotics and milk or milk products (butter, yoghurt, cream, cheese, etc.) only affects certain antibiotic active ingredients. Most antibiotics are safe when taken with milk.

What antibiotics do not use milk

Which antibiotics should not be combined with milk or dairy products (butter, yoghurt, cream, cheese, etc.):2,4

  • Fluoroquinolones: e.g. ciprofloxacin, norfloxazine, gatifloxacin
  • Tetracyclines: e.g., doxycycline, minocycline

Antibiotics that are barely affected by milk:

  • Penicillins: e.g. ampicillin, amoxicillin, penicillin G, penicillin V (often with bacterial tonsillitis / angina)
  • Macrolides: Erythromycin, Clarithromycin, Azithromycin (often with stye)
  • Lincosamides: e.g. clindamycin (often for tooth infections)
  • Sulfonamides: e.g. cotrimoxazole = combination of trimethoprim and sulfamethoxazole (often for bladder infections)
  • Fluoroquinolones: Ofloxacin, Levofloxacin, Moxifloxacin
  • Cephalosporins: e.g. cefaclor, cefixime

Many other interactions with antibiotics are possible, so always read the package insert or ask your doctor or pharmacist.

Why Avoid Antibiotics With Milk?

Some antibiotics should not be taken together with milk or milk products (butter, yoghurt, cream, cheese, etc.).

The reason is simple: that contained in milk or dairy products Calcium can delay or reduce the absorption of the antibiotic, so that not enough active ingredient may reach the source of the infection.

Avoid the simultaneous use of the above antibiotics with milk or milk products that are rich in calcium. Food supplements that contain calcium and other nutrients such as magnesium and zinc should also be avoided as they can dampen the effects of antibiotics.3

Calcium is an important nutrient for human health. It is one of the building blocks for bones and teeth, but also necessary for blood clotting, muscles and nerves. Calcium is found in milk and dairy products, among other things.3 However, some antibiotics can form poorly soluble compounds with calcium from milk or milk products, as well as with magnesium and zinc, in the stomach and upper small intestine.2 It is now also assumed that the casein contained in milk also forms such complexes. The result: the absorption of the antibiotic into the blood is hindered and the antibiotic concentration at the focus of the infection may decrease or even fail completely.4,5,6

Therefore: Avoid milk for at least two hours before and after taking certain antibiotics - including calcium-rich mineral water and milk products such as cheese, quark or yoghurt. Basically, antibiotics - no matter which one - are best swallowed with a large glass of tap water.7

Other examples in which calcium, e.g. from milk, should be avoided are osteoporosis agents such as bisphosphonates (e.g. alendronic acid or risedronic acid) and the thyroid hormone L-thyroxine.8

How much milk is allowed with antibiotics?

Even small amounts of milk, e.g. milk that is added to coffee or black tea, can impair the absorption of tetracycline into the blood. However, studies have shown that food-drug interactions can be avoided by using coated tablets, which do not disintegrate until they reach the middle to lower area of ​​the small intestine.2,9

Since even small amounts of milk or dairy products can impair the effectiveness of certain antibiotics, we do not recommend taking these antibiotics with a sip of white coffee in the morning, for example, or eating yoghurt or sandwiches with them.

Distance between milk and antibiotics

Sometimes antibiotics are to be taken with meals, but sometimes with a little space before or after. For example, antibiotics such as tetracycline should be taken one hour before or two hours after meals and not with milk. This is because the drug can form insoluble compounds with the calcium contained in milk, which prevent the antibiotic from being absorbed into the blood.2

To avoid any interaction between the antibiotic and milk or milk product, an interval of up to 3 hours must be observed.3

How and when to take your antibiotic best can be found in the package insert for your medication or ask your doctor or pharmacist what you should be aware of when using it.

Antibiotics and dairy products

Dairy products can also impair the effectiveness of certain antibiotics, including tetracycline (also: tetracycline), doxycycline, cefaclor and ciprofloxacin.

Many patients ask themselves questions such as:

"Can I eat a little yoghurt in the morning despite the antibiotic?"
"I don't have to leave out the butter with antibiotics, do I?"
"Does the antibiotic treatment really bother me if I just put a small slice of cheese on the bread?"

The answer is simple. With the antibiotics mentioned above, such as tertacycline and ciprofloxacin, simultaneous use should always be avoided:

  • Antibiotics and butter
  • Antibiotics and yogurt
  • Antibiotics and cheese
  • Antibiotics and calcium-rich vegetables (spinach leaves, broccoli)
  • Antibiotics and calcium-rich mineral water (over 150 mg calcium per liter)

Antibiotics and fruit juice

You only have to do without orange juice or grapefruit juice if they are also enriched with calcium. Because that can also dampen the effect of some antibiotics. Please note the nutritional information of the corresponding drink.3

Antibiotics and coffee, black tea or cola

Antibiotics, especially fluoroquinolones (e.g. ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin) should, if possible, not be taken with coffee or other caffeinated beverages such as black tea or cola. Some antibiotics inhibit the breakdown of caffeine, which can have a stimulating effect. Palpitations, sleep disorders and restlessness can result.10

Antibiotics and alcohol

The combination of antibiotics and alcohol should not be underestimated. Alcohol can increase side effects such as upset stomach, dizziness and drowsiness, among other antibiotics.

Under no circumstances should alcohol be consumed while taking some antibiotics, such as metronidazole, as this can lead to an overreaction. Even drinking tiny amounts of alcohol can cause side effects such as flushing, headaches, nausea and vomiting, and a rapid heart rate with these drugs. The antibiotic linezolid in combination with alcohol can cause a dangerous rise in blood pressure.

Remember that some medicines and mouthwashes also contain alcohol. So check the label and avoid such products while taking the above antibiotics.

Although modest alcohol consumption does not affect the effectiveness of most antibiotics, the added stress of alcohol can delay recovery. It is therefore always a good idea to avoid alcohol until you have finished your antibiotic treatment and are feeling better.11

Antibiotics - you should also consider that

Diet for antibiotics

Antibiotics are prescribed by the doctor to fight bacterial infections. The diet during antibiotic therapy has a decisive influence on how well the drug works and how well it is tolerated.

>> Read here: What to eat while taking antibiotics?

Build up and clean up the intestinal flora after taking antibiotics

Therapy with antibiotics (med. Antibiosis) unfortunately also destroys a large part of the beneficial bacteria in the intestine. Therefore, it makes sense to protect the intestinal flora (microbiota) during antibiosis and not only start with the intestinal rehabilitation when a large part of the microbiome has suffered from the antibiotic. Repopulation of the intestine does not happen overnight, much like reforestation after a forest fire. But the earlier you start (preferably from day 1), the faster a diverse intestinal colonization will be restored.

You can do that: Help your intestinal flora with a probiotic intestinal rehabilitation, e.g. with Innovall® AID. Note that stress can also weaken the body's defenses. Make sure you have enough rest to allow your body to recover from the disease and the treatment.

Antibiotics and other drugs

Antibiotics can interact not only with milk, but also with other drugs that must be taken in parallel. In order for all drugs to work properly, there are a few basic things to keep in mind.

>> Find out everything you need to know about taking antibiotics here.

You can find out what interactions your antibiotic has in the package insert for your medication or ask your doctor or pharmacist what you should consider when using it.

Frequent questions and answers

Which antibiotics do not combine with milk?

The general advice to avoid milk and antibiotics is a myth. Because the interaction between antibiotics and milk or milk products (butter, yoghurt, cream, cheese, etc.) only affects certain antibiotic active ingredients. Most antibiotics and milk are safe.
Which antibiotics should not be combined with milk or dairy products are:2,11

  • Fluoroquinolones: e.g. Ciprofloxacin, Norfloxazin, Ofloxacin, Levofloxacin, Moxifloxacin, Gatifloxacin
  • Tetracyclines: e.g., doxycycline, minocycline
  • Cephalosporins: e.g. cefaclor, cefixime

Why not drink milk with antibiotics?

Some antibiotics can form poorly soluble compounds with calcium from milk or milk products in the stomach and upper small intestine.2 It is now also assumed that the casein in milk forms such complexes. The result: the absorption of the antibiotic into the blood is hindered and the antibiotic concentration at the focus of the infection may decrease or even fail completely.2,12,13

Antibiotics and milk - how long do you have to wait?

For example, certain antibiotics such as tetracycline should be taken one hour before or two hours after meals and not with milk, as it forms insoluble compounds with the calcium in milk that prevent the antibiotic from being absorbed into the blood.2
The general rule is to keep an interval of up to 3 hours between the antibiotic and milk or milk product in order to avoid possible interactions.3

How and when it is best to take your antibiotic can be found in the package insert for your medication or ask your doctor or pharmacist what you should consider when using it.