Disulfiram-like reaction associated with a parenteral cephalosporin

A disulfiram-like reaction attributed to cefoperazone, an investigational cephalosporin, is reported. Cefoperazone (T-1551, Pfizer Pharmaceuticals, Inc.), a semisynthetic, parenteral cephalosporin undergoing clinical trials in the United States, was administered in single 1-, 2-, and 3-g doses to 12 healthy volunteers. The drug was administered as a 5% solution by constant infusion over a five-minute period, and one week was allowed between doses. Approximately 25 hours after receiving the 3-g dose, one subject experienced facial flushing after drinking 12 fluid ounces of beer. A second ingestion of 24 ounces of beer eight hours later produced facial flushing, tachycardia, diaphoresis, and pounding headache; the symptoms lasted 1.5-2 hours. A subsequent rechallenge with beer five hours later produced an identical reaction, but the symptoms subsided rapidly. Further rechallenge 60 hours after receiving the drug produced no ill effects. No such reaction appears to have been reported previously as being associated with the administration of a cephalosporin.