Antibiotic precedes auto-brewery relapse

A patient developed severe endogenous alcohol intoxication 5 days after starting treatment following approximately 2 years without symptoms.

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A man with known auto-brewery syndrome developed severe endogenous ethanol intoxication 5 days after starting amoxicillin/clavulanate for pneumonia.
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His blood alcohol concentration was 43.6 mmol/L despite reported abstinence, and he recovered within hours with supportive care after the antibiotic was stopped.
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Before the relapse, he had small intestinal bacterial overgrowth and increased Proteobacteria, predominantly Enterobacter species; rifaximin and probiotics preceded about 2 symptom-free years.
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The authors proposed that antibiotic-associated gut dysbiosis may have contributed to recurrence, but the single-patient case could not establish that amoxicillin/clavulanate caused it.
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The authors advised considering auto-brewery syndrome in otherwise unexplained intoxication when abstinence is credible and approaching antibiotic therapy cautiously in patients with known syndrome.

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