Perazella M A
Department of Medicine, Yale University School of Medicine, New Haven, USA.
Conn Med. 1997 Aug;61(8):451-8.
Trimethoprim-sulfamethoxazole is a frequently prescribed antibiotic with a wide spectrum of antimicrobial activity. A previously unreported and potentially lethal adverse reaction associated with "high dose" trimethoprim-sulfamethoxazole therapy, hyperkalemia, was described. Subsequent to the descriptions of hyperkalemia with "high dose" trimethoprim-sulfamethoxazole, a handful of cases noted the development of hyperkalemia with "standard dose" trimethoprim-sulfamethoxazole in elderly patients without evidence of an obvious defect in potassium homeostasis. A surveillance study of patients treated with "standard dose" trimethoprim-sulfamethoxazole as compared to similar controls treated with other antibiotics confirmed the rise in potassium associated with trimethoprim-sulfamethoxazole therapy. Recognition of this potassium disorder led to investigation and description of the mechanism by which trimethoprim-sulfamethoxazole-induced hyperkalemia. Trimethoprim was found to act like the potassium-sparing diuretic amiloride and reduce renal potassium excretion. Hence, trimethoprim-sulfamethoxazole therapy was found to be associated with a new adverse reaction, hyperkalemia, nearly 25 years after its introduction into clinical practice as an antimicrobial agent.
甲氧苄啶-磺胺甲恶唑是一种常用的抗生素，具有广泛的抗菌活性。本文描述了一种与“高剂量”甲氧苄啶-磺胺甲恶唑治疗相关的、此前未报告的潜在致命不良反应——高钾血症。在报道了“高剂量”甲氧苄啶-磺胺甲恶唑导致高钾血症之后，有少数病例指出，在没有明显钾稳态缺陷证据的老年患者中，“标准剂量”的甲氧苄啶-磺胺甲恶唑也会导致高钾血症。一项针对接受“标准剂量”甲氧苄啶-磺胺甲恶唑治疗的患者与接受其他抗生素治疗的类似对照组的监测研究证实，甲氧苄啶-磺胺甲恶唑治疗会导致血钾升高。对这种钾紊乱的认识促使人们对甲氧苄啶-磺胺甲恶唑诱发高钾血症的机制进行了研究和描述。研究发现，甲氧苄啶的作用类似于保钾利尿剂阿米洛利，可减少肾脏钾排泄。因此，在甲氧苄啶-磺胺甲恶唑作为抗菌药物引入临床实践近25年后，发现其治疗与一种新的不良反应——高钾血症有关。
