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Antibiotic-Induced Hyperkalemia and Renin-Angiotensin–System Inhibitors July 25, 2010
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Kenneth E. Korber, PA About the Author
Kenneth E. Korber, PA

 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) in these elderly patients.
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.
Reference: Antoniou T et al. Antibiotic-induced hyperkalemia and Renin-Angiotensin–System inhibitors.  Arch Intern Med 2010 Jun 28; 170:1045

Ken Korber, PA 

Ken Korber is a PA in Chicago and the architect of the first PA postgraduate fellowship curriculum for cardiovascular care in the United States. He can be reached at his email address, kenneth.korber@gmail.com, for any comments or questions.

 The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

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