Related Experiment Video
Updated: Aug 30, 2025
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
13.0K
Trimethoprim-associated hyperkalaemia: a systematic review and meta-analysis
Pietro B Faré1, Erica Memoli2, Giorgio Treglia3,4
1Infectious Diseases Division, Department of Medicine, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
The Journal of Antimicrobial Chemotherapy
|August 26, 2022
Summary
Trimethoprim can cause hyperkalemia, especially at higher doses or with certain other medications. This risk is increased in patients with poor kidney function and typically appears within a week of starting treatment.
Area of Science:
- Pharmacology
- Nephrology
- Internal Medicine
Background:
- Trimethoprim, a widely used antibiotic, shares structural similarities with potassium-sparing diuretics.
- Its potential to induce hyperkalemia (high potassium levels) is recognized but not extensively studied.
- The prevalence and risk factors for trimethoprim-associated hyperkalemia require further investigation.
Purpose of the Study:
- To systematically review and synthesize the available literature on trimethoprim-associated hyperkalemia.
- To determine the pooled prevalence of hyperkalemia in patients treated with trimethoprim.
- To identify factors that predispose individuals to developing hyperkalemia while on trimethoprim therapy.
Main Methods:
- A comprehensive literature search was conducted across major databases (National Library of Medicine, Embase, Web of Science) without date or language restrictions.
- The review adhered to Economic and Social Research Council and PRISMA guidelines for systematic reviews.
- Eighteen reports, each including at least 10 subjects treated with trimethoprim and assessing hyperkalemia, were included in the final analysis.
Main Results:
- The pooled prevalence of potassium levels >5.0 mmol/L, >5.5 mmol/L, and >6.0 mmol/L or symptomatic hyperkalemia was 22%, 10%, and 0.2%, respectively.
- Hyperkalemia risk was dose-dependent and exacerbated by co-administration of potassium-sparing diuretics, renin-angiotensin-aldosterone system inhibitors, beta-blockers, and NSAIDs.
- Impaired kidney function significantly increased the risk, with hyperkalemia onset typically occurring within one week of initiating trimethoprim.
Conclusions:
- This analysis confirms the hyperkalemic potential of trimethoprim, an antibiotic prescribed for over 50 years.
- Clinicians should be vigilant in identifying and monitoring patients at risk for trimethoprim-induced hyperkalemia.
- Awareness of risk factors and drug interactions is crucial for safe trimethoprim use.
Related Concept Videos
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
717
Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
717
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
55
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
55
01:20Acute Kidney Injury V: Interprofessional Care
42
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
42
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
35
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
35
01:28Chronic Kidney Disease III: Interprofessional Care
73
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
73
01:29Acute Kidney Injury II: Pathophysiology
59
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
59