Baktar(TMP/SMX)和老人家使用ACEI/ARB後的高血鉀有關

又是一個健保database的study



Antibiotic-Induced Hyperkalemia and Renin-Angiotensin–System Inhibitors

Among older patients who were receiving renin-angiotensin–system inhibitors, trimethoprim-sulfamethoxazole (but not other antibiotics) increased the risk for hyperkalemia.

Recent years have seen greatly increased use of renin-angiotensin system inhibitors, including angiotensin-converting–enzyme inhibitors and angiotensin-receptor blockers. With this increase, we should expect a rise in novel drug interactions.

Knowing that hyperkalemia has been associated both with renin-angiotensin–system inhibitors and with trimethoprim, investigators in Toronto performed a population-based, nested case-control study among older patients (aged ≥66) who were receiving continuous treatment with one of these blockers and had also been prescribed trimethoprim-sulfamethoxazole (TMP-SMX), ciprofloxacin, norfloxacin, nitrofurantoin, or amoxicillin. Cases (371 patients who were hospitalized between 1994 and 2008 for treatment of hyperkalemia ≤14 days after receiving an antibiotic of interest) were each matched with one to four controls (similar patients without such hospitalization before the index date).

The risk for hyperkalemia-associated hospitalization within 14 days of antibiotic prescription was nearly sevenfold higher with TMP-SMX than with amoxicillin (adjusted odds ratio, 6.7; 95% confidence interval, 4.5–10.0). Findings were similar when the index hospitalization occurred within 7 days of antibiotic prescription. No association was seen between use of any of the other study antibiotics and development of hyperkalemia.

Comment: These findings should prompt us to consider using an alternative to TMP-SMX, if feasible, among older patients who are receiving renin-angiotensin–system inhibitors.

— Larry M. Baddour, MD

Published in Journal Watch Infectious Diseases July 14, 2010
Citation(s):

Antoniou T et al. Trimethoprim-sulfamethoxazole–induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: A population-based study. Arch Intern Med 2010 Jun 28; 170:1045.

* Original article (Subscription may be required)
* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7YWFlYzU0Y2EtMjU0Ni00ODc3LWI4NjItMjhiN2Y3MjNlMjI1&hl=zh_TW

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