Effect of Standard-Dose Trimethoprim/Sulfamethoxazole on the Serum Potassium Concentration in Elderly Men

Witt, James M; Koo, Ji M.; Danielson, Byron D.

doi:10.1177/106002809603000404

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…Of interest is that these were never cited reasons in the kidney transplant population. Drug‐induced nephrotoxicity (from interstitial nephritis) and hyperkalemia are well‐documented in the setting of TMP‐SMX therapy 9,26 . Reports of studies comparing TMP‐SMX to placebo for infection prophylaxis in kidney transplant recipients do not detect discernible TMP‐SMX induced renal toxicity, 22 though case reports of interstitial nephritis are rarely reported 26 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, TMP‐SMX may prevent other OIs, including Toxoplasma , Nocardia, and Listeria infections 5‐7 . Side effects attributed to TMP‐SMX including myelotoxicity, allergic reactions, rash, hyperkalemia, hepatitis, interstitial nephritis, pancreatitis, and aseptic meningitis may lead to the utilization of second line alternative prophylactic agents (APAs) such as aerosolized pentamidine, dapsone, or atovaquone 4,8‐10 . However, such TMP‐SMX side effects are unlikely when used at 1 double strength three times a week or 1 single strength daily 10‐13 .…”

Section: Introductionmentioning

confidence: 99%

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Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Lum

Echenique

Athans

et al. 2020

Transplant Infectious Dis

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Background Trimethoprim‐sulfamethoxazole (TMP‐SMX) is the drug of choice for Pneumocystis jirovecii pneumonia (PJP) prophylaxis and has activity against other opportunistic infections (OIs) after solid organ transplant (SOT). We aimed to describe the incidence, reasons for and outcomes of use of alternative prophylactic agents (APAs) across SOT programs in our high volume centers. Methods Solid organ transplant recipients (SOTRs) at our centers from 1/2015‐12/2016 were identified. Pharmacy records identified APA (pentamidine, atovaquone, or dapsone) use within 1 year. Records were reviewed for allergies, laboratory values at APA initiation, diagnostic tests for TMP‐SMX‐preventable OIs, and APA side effects. Results An APA was initiated in 105/1173 (8.9%) SOTRs. Of these, 51 (48.6%) were because of sulfonamide allergy recorded pre‐SOT, mostly rash/hives (58.8%). The remaining 54 (51.4%) had TMP‐SMX discontinued post‐SOT, mostly for neutropenia (48%) and renal effects (34%). Differences occurred across programs, with kidney transplant never stopping TMP‐SMX for renal issues. Of those changed to APAs post‐transplant, 19 (35%) were later successfully re‐challenged with TMP‐SMX. With thresholds in mind, 67 (64%) received an APA unnecessarily, accounting for up to $100 000/y excess cost. Potential TMP‐SMX‐preventable OIs occurred in 7 (5 Nocardia; 2 PJP). APA side effects occurred in 14/105 (13.3%). Conclusions Use of APAs for PJP prophylaxis after SOT is less than previously reported but often unwarranted. Such decisions require scrutiny to avoid TMP‐SMX‐preventable OIs, cost and important APA side effects. Use of reasonable thresholds for cessation of TMP‐SMX and data‐driven approaches to re‐challenge would substantially reduce APA use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Lum

Echenique

Athans

et al. 2020

Transplant Infectious Dis

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“…10,11 Hyperkalaemia has also been reported in patients treated with standard doses of trimethoprim+sulfamethoxazole. [12][13][14][15] The risk of hyperkalaemia is increased if trimethoprim+ sulfamethoxazole is concurrently prescribed with drugs that can increase plasma potassium concentration. A recent study reported a major increase in the risk of hyperkalaemia-associated hospitalisation if trimethoprim+ sulfamethoxazole (as opposed to other antibiotics) was prescribed concurrently with angiotensin converting enzyme inhibitors or angiotensin receptor blockers.…”

Section: Introductionmentioning

confidence: 99%

Plasma Potassium Concentration Changes Associated with Trimethoprim used for Urinary Tract Infections

Kowalski

Tan

2010

Pharmacy Practice and Res

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Background: Hyperkalaemia has been reported with highdose trimethoprim (20 mg/kg/day) and standard-dose trimethoprim (6 mg/kg/day) plus sulfamethoxazole use. Aim: To investigate changes in plasma potassium concentrations in patients prescribed standard-dose trimethoprim 300 mg daily for urinary tract infections. Method: A retrospective cohort study of hospital patients with urinary tract infections treated with trimethoprim or other antibacterials (control group) for more than 5 days. Plasma potassium concentration, creatinine and urea were compared at baseline and at the completion of treatment. Results: There were 31 patients in the trimethoprim group and 65 patients in the control group. End-of-therapy mean plasma potassium concentrations increased significantly from baseline in the trimethoprim group (4.2 ± 0.4 mmol/L to 4.5 ± 0.5 mmol/L; p = 0.002) but not in the control group. End-oftherapy mean plasma potassium concentrations were also higher in the trimethoprim group (4.5 ± 0.5 mmol/L vs 4.2 ± 0.5 mmol/L; p = 0.007). 65% of the trimethoprim group developed end-of-therapy hyperkalaemia versus 39% of the control group. Mean creatinine concentration in the trimethoprim group increased by an average of 21% from baseline but did not change in the control group. The trimethoprim group showed no change in mean urea concentration but a decrease was noted in the control group. Conclusion: Treating urinary tract infections with trimethoprim 300 mg daily for more than 5 days was associated with an increase in plasma potassium concentration.

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Disorders of Potassium Balance

Plamondon¹,

Leblanc²

2009

Critical Care Nephrology

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Effect of Standard-Dose Trimethoprim/Sulfamethoxazole on the Serum Potassium Concentration in Elderly Men

Cited by 5 publications

References 24 publications

Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Alternative pneumocystis prophylaxis in solid organ transplant recipients at two large transplant centers

Plasma Potassium Concentration Changes Associated with Trimethoprim used for Urinary Tract Infections

Disorders of Potassium Balance

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