Co-trimoxazole induced hyperkalemia and potassium monitoring in hospitalized patients
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RESEARCH ARTICLE
Co‑trimoxazole induced hyperkalemia and potassium monitoring in hospitalized patients Milan M. E. A. Plantaz1 · Bart A. J. Veldman2 · Anne C. Esselink2 · Hanneke W. H. A. Fleuren1 · Cornelis Kramers1,3 Received: 25 November 2019 / Accepted: 15 April 2020 © Springer Nature Switzerland AG 2020
Abstract Background Co-trimoxazole is an antibiotic combination used for the treatment of Pneumocystis jirovecii pneumonia, amongst others. Co-trimoxazole is known to increase serum potassium. For this reason, Dutch guidelines advise serum potassium monitoring in high-risk patients. Objective This study aimed to determine average serum potassium rise after administration of intravenous co-trimoxazole in hospitalized patients, compared to intravenous ceftriaxone. This study also aimed to determine adherence to Dutch guidelines by measuring the incidence of serum potassium monitoring in these patients. Setting Data was collected retrospectively from patients in five departments of the Canisius Wilhelmina Hospital, a teaching hospital in Nijmegen, the Netherlands. Method Data was collected and compared from patients that received intravenous co-trimoxazole (n = 66) and intravenous ceftriaxone (n = 132) in the period of November 2008–November 2017. For each patient using co-trimoxazole, two patients using ceftriaxone were included in a paired fashion. Baseline and follow-up potassium were collected, if available. Additionally, it was tested if serum potassium was measured around the initiation of antibiotic therapy. Main outcome measure Changes in serum potassium where obtainable in 30 patients using cotrimoxazole and 40 patients using ceftriaxone. When compared to ceftriaxone, administration of intravenous co-trimoxazole was associated with a significant mean increase in serum potassium (+0.55 mmol/l, 95% CI 0.29–0.80, p 70 years, patients with diabetes or heart failure, patients that use other potassium-elevating medication and patients who receive high doses of the drug for the treatment of PJP.’ [8] Even though co-trimoxazole is mostly prescribed orally, it is also prescribed intravenously, mainly for hospitalized patients who suffer from severe PJP and for those who cannot take the drug orally. Generally, patients who receive intravenous co-trimoxazole are sicker and more vulnerable than patients on oral treatment. The serum potassium rising effect of cotrimoxazole is in hospitalized patients that receive the drug intravenously is presently unknown.
The local Canisius Wilhelmina Ziekenhuis (CWZ) ethical committee approved this study under identification number CWZ-064-2019. This study is not subject to the Dutch WMO-law regarding scientific-medical research concerning humans (wet Wetenschappelijk Medisch Onderzoek met mensen). This study has been registered in the Dutch trial database under study identification number NTR7608.
Aim of the study This study aimed to determine average rise in serum potassium in hospitalized patients receiving intravenous co-trimoxazole, as compared to hospitalized pat
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