Gentry Chris A, Nguyen Ann T
Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA.
Ann Pharmacother. 2013 Dec;47(12):1618-26. doi: 10.1177/1060028013509973. Epub 2013 Oct 25.
Adverse events associated with high-dose trimethoprim-sulfamethoxazole (TMP-SMX) for outpatient infections, particularly those likely caused by community-acquired methicillin-resistant Staphylococcus aureus, have not been adequately characterized.
Describe hyperkalemia and acute renal injury associated with high-dose TMP-SMX.
An electronic medical record database retrospective study was conducted of outpatients receiving high-dose or low-dose TMP-SMX, comparing the incidences of hyperkalemia and acute renal injury.
Of 6162 patients, more developed hyperkalemia (3.06% vs 1.05%, P < .0001) or acute renal injury (1.99% vs 0.700%, P = .0001) in the high-dose TMP-SMX group. Variables independently associated with hyperkalemia included age >58 years (odds ratio [OR] = 3.44; 95% CI = 1.86-7.0; P < .0001), concomitant receipt of an NSAID (OR = 1.71; 95% CI = 1.02-2.79; P = .044) or an ACE inhibitor (OR = 3.27; 95% CI = 2.06-5.14; P < .0001), high-dose TMP-SMX prescribed (OR = 2.92; 95% CI = 1.85-4.60; P < .0001), and baseline elevated serum creatinine (OR = 45.1; 95% CI = 21.7-93.2; P < .0001). Variables independently associated with acute renal injury included concomitant receipt of an ACE inhibitor (OR = 2.36; 95% CI = 1.01-5.24; P = .048) or a potassium supplement (OR = 4.10; 95% CI = 1.45-10.1; P = .010), high-dose TMP-SMX prescribed (OR = 3.70; 95% CI = 1.70-8.12; P = .0012), and baseline elevated serum creatinine (OR = 2110; 95% CI = 724-7980; P < .0001).
Serum creatinine and potassium concentrations should be monitored in outpatients receiving high-dose TMP-SMX.
高剂量甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）用于门诊感染相关的不良事件，尤其是那些可能由社区获得性耐甲氧西林金黄色葡萄球菌引起的感染，尚未得到充分描述。
描述与高剂量TMP - SMX相关的高钾血症和急性肾损伤。
对接受高剂量或低剂量TMP - SMX的门诊患者进行电子病历数据库回顾性研究，比较高钾血症和急性肾损伤的发生率。
在6162例患者中，高剂量TMP - SMX组更多患者出现高钾血症（3.06%对1.05%，P <.0001）或急性肾损伤（1.99%对0.700%，P =.0001）。与高钾血症独立相关的变量包括年龄>58岁（比值比[OR]=3.44；95%置信区间[CI]=1.86 - 7.0；P <.0001）、同时接受非甾体抗炎药（OR =1.71；95% CI =1.02 - 2.79；P =.044）或血管紧张素转换酶抑制剂（OR =3.27；95% CI =2.06 - 5.14；P <.0001）、开具高剂量TMP - SMX（OR =2.92；95% CI =1.85 - 4.60；P <.0001）以及基线血清肌酐升高（OR =45.1；95% CI =21.7 - 93.2；P <.0001）。与急性肾损伤独立相关的变量包括同时接受血管紧张素转换酶抑制剂（OR =2.36；95% CI =1.01 - 5.24；P =.048）或补钾剂（OR =4.10；95% CI =1.45 - 10.1；P =.010）、开具高剂量TMP - SMX（OR =3.70；95% CI =1.70 - 8.12；P =.0012）以及基线血清肌酐升高（OR =2110；95% CI =724 - 7980；P <.0001）。
接受高剂量TMP - SMX的门诊患者应监测血清肌酐和钾浓度。
