Research suggests the two may work better together to fight certain infections. Here’s what you need to know before picking up this combo.
If you have rheumatoid arthritis (RA), chances are you are taking or have taken some kind of steroid. In low doses, steroids can help relieve joint pain from your rheumatoid arthritis. It’s also common for doctors to prescribe a short-term course of a steroid, such as prednisone, to get you through a particularly difficult flare-up of RA.
However, when taking a steroid, you must be careful before combining it with other drugs, such as antibiotics. Many people wonder: is it okay to take antibiotics with steroids? Can the steroid improve the antibiotic? We asked top medical experts to set the record straight about taking steroids and antibiotics at the same time.
Difference Between Steroids and Antibiotics
Steroids (also known as corticosteroids) are drugs that decrease inflammation in the body. Doctors often prescribe them to treat inflammation and swelling of the joints, such as those that result from rheumatoid arthritis. Steroids are also used to treat allergic reactions, help fight respiratory conditions such as asthma, and calm an overactive immune system in people with autoimmune diseases such as lupus and rheumatoid arthritis, where the system immune system mistakenly attacks healthy tissue. Some common types of oral corticosteroids are cortisone, dexamethasone, methylprednisolone, and prednisone.
Antibiotics work a little differently. “Antibiotics have an antibacterial effect — they target bacteria when you have an infection,” says Alia Aaeedy, director of pharmacy at Texas Surgical Hospital in Plano, TX. So, for example, you might take an antibiotic to fight an infection like strep throat, an ear infection, or a sinus infection. But because it kills bacteria, an antibiotic doesn’t help fight viruses like the common cold, flu, or COVID-19.
There are many classes and types of antibiotics, including penicillin (amoxicillin, flucloxacillin), tetracyclines (doxycycline, cephalosporins), macrolides (erythromycin, azithromycin, clindamycin), and sulfonamides (metronidazole).
Can you take steroids and antibiotics at the same time?
The answer to this question depends on the specific steroid, antibiotic, and infection, but yes, in some cases your doctor may prescribe both drugs at the same time. The antibiotic targets the bacteria and the steroid controls the inflammation and resulting pain. For example, the steroid dexamethasone has been shown to be effective in adults with bacterial meningitis, according to a study in The New England Journal of Medicine. The two are also often prescribed together for upper respiratory tract infections.
Drug interactions between steroids and antibiotics
Nevertheless, there are some potential interactions you should be aware of when taking both oral steroids and antibiotics. Here are the most common ones to consider. Always speak with your provider if you are unsure about drug interactions or have any follow-up questions.
Dexamethasone and antibiotics
There is a potential interaction between dexamethasone, a type of steroid, and certain antibiotics. “Dexamethasone and the antibiotic levofloxacin [part of the quinolone class of drugs] should not be used together due to increased risk of tendon rupture,” says Madison. The antibiotic erythromycin can increase the amount of dexamethasone in your system, increasing your risk of side effects.
Prednisone and antibiotics
All corticosteroids, including prednisone, carry the risk of interacting with quinolone antibiotics (levofloxacin, ciprofloxacin) and causing rupture of a tendon (tissue that connects muscle to bone). Mixing prednisone and penicillin antibiotics such as amoxicillin is considered safe, Madison says.
Can you drink alcohol while taking antibiotics or steroids?
There’s a reason doctors tell patients not to drink while on medication, and it’s not because a glass of wine or a beer will make antibiotics less effective. Alcohol can increase your risk of side effects when you take certain medications. You should avoid alcohol while taking certain antibiotics such as Flagyl (metronidazole), Tindamax (tinidazole), and Bactrim (sulfamethoxazole). The combo can lead to nausea, vomiting, rapid heartbeat, and headaches.
There are no known interactions between alcohol and steroids such as prednisone, but drinking large amounts of alcohol can increase your side effects, including stomach upset. “You might have heartburn, acid reflux, or gas,” says Aaeedy. To be safe, avoid drinking while taking oral steroids or, at the very least, limit your intake.
Side effects of steroids and antibiotics
Every medication carries a risk of side effects, and steroids and antibiotics are no different. But in the case of these two drugs, the side effects can be worse when combined. “Most of the side effects are related to gastrointestinal toxicity,” says Madison. For example, common side effects of antibiotics are nausea, diarrhea, and upset stomach. Corticosteroids can also cause stomach upset and cramps because they irritate the stomach lining. So, in short, the combination of antibiotics and steroids can increase the risk of stomach problems.
Why doctors prescribe steroids with antibiotics
When you are sick, your doctor may prescribe both an oral steroid and an antibiotic. This is intended to speed up your healing. “The steroid reduces swelling and inflammation from an infection – for example, swelling in the sinus area in the case of a sinus infection – so healing will be faster,” says Aaeedy.
Do steroids increase the effectiveness of antibiotics?
Some research has suggested that the two drugs work better together than either alone for treating certain infections. For example, a recent study found that corticosteroids and antibiotics were more effective together in the treatment of bacterial meningitis. To research in mice also showed that taking steroids and antibiotics at the same time improved recovery time for people with pneumonia. To be clear: researchers don’t believe that steroids make antibiotics more effective, but by reducing inflammation, the infection may resolve more quickly.
In summary, it’s safe to take most antibiotics with steroids, and the combination may even help you recover from an infection faster.