On receipt of prescriptions for antibiotics, pharmacy staff should ask patients three key questions:

• What has the antibiotic has been prescribed for?
  This is to help ensure appropriateness. In addition, before reconstituting liquid antibiotics, it is worth checking if the course is to start immediately or if it is for a delayed prescription, as some patients may not realise the short expiry once reconstituted.
• Are there any known allergies?
  Record allergies on the PMR system.
• If applicable, have they had their flu vaccination?

When handing over the dispensed antibiotics, patients should be provided with the following key messages and encouraged to ask questions:

• Take the medicine as prescribed (state dose, frequency and duration)
• Don’t share antibiotics with others or reuse them after the stated duration
• Return any unused antibiotics to the pharmacy (do not dispose of them at home by, for example, flushing down the toilet or sink).

Patients should also be advised on alcohol intake with antibiotics. While it is sensible to avoid drinking alcohol when taking medication or feeling unwell, only metronidazole and tinidazole require complete abstinence from alcohol during the course and for 48 hours (metronidazole) and 72 hours (tinidazole) after its completion. Anecdotally, many members of the public believe they cannot drink any alcohol with all antibiotics and stop courses early because of this.

Alcohol can cause a serious (disulfiram-like) reaction when combined with these two azole medications. Symptoms of a disulfiram-like reaction include breathlessness, headache, chest pain, skin flushing, increased or irregular heartbeat, light headedness, and nausea and vomiting.

Other antibiotics that alcohol can interact with (and where caution is required) include:

• Co-trimoxazole: similar reaction to that of metronidazole or tinidazole, although this is very rare; alcohol in moderation does not normally cause a problem
• Linezolid: undistilled (fermented) alcoholic drinks such as wine, beer, sherry and lager can interact with linezolid
• Doxycycline: alcohol intake, especially in people with a history of chronic alcohol consumption, can reduce the effectiveness of doxycycline
• Erythromycin: alcohol may slightly reduce or delay its effect.