Which antibiotic can cause a disulfiram-like reaction with alcohol?

Metronidazole is the antibiotic that can cause a disulfiram-like reaction when consumed with alcohol. This reaction occurs because metronidazole inhibits the enzyme aldehyde dehydrogenase, which is responsible for metabolizing acetaldehyde, a metabolite of ethanol. When alcohol is ingested simultaneously with metronidazole, acetaldehyde accumulates in the body, leading to various unpleasant symptoms such as flushing, palpitations, nausea, and vomiting, reminiscent of those experienced with disulfiram (Antabuse), a drug used to treat alcohol dependence.

This characteristic makes it crucial for clinicians to advise patients undergoing treatment with metronidazole to avoid alcohol consumption to prevent these adverse effects. The other antibiotics listed do not have a known interaction with alcohol that leads to a disulfiram-like reaction, thus further emphasizing metronidazole's unique profile in this regard.