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The Risks of Using Trimethoprim/Sulfamethoxazole in Patients with Renal and Cardiac Compromise

Arlene F Hoffman1, Tzu Lu Lin2

  • 1*Private practice, San Francisco, CA; Department of Medicine and Surgery, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA.

Journal of the American Podiatric Medical Association
|October 17, 2022
PubMed

Insights

Trimethoprim/sulfamethoxazole (TMP/SMX) can cause serious adverse events, particularly in patients with kidney or cardiac issues, hyperkalemia, or those on interacting medications. Physicians should carefully weigh risks and consider safer antibiotic alternatives.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Nephrology

Background:

  • Trimethoprim/sulfamethoxazole (TMP/SMX) is commonly prescribed for leg and foot skin infections, including those caused by methicillin-resistant Staphylococcus aureus.
  • Despite its frequent use, TMP/SMX carries significant risks that necessitate careful consideration in patient selection.

Purpose of the Study:

  • To inform physicians about the potential dangers of prescribing TMP/SMX.
  • To highlight specific patient populations and medication interactions that increase adverse event risk.

Main Methods:

  • Review of existing literature on TMP/SMX adverse effects.
  • Presentation of a case study demonstrating a life-threatening complication associated with TMP/SMX use.

Main Results:

  • TMP/SMX is associated with numerous adverse effects, including potentially life-threatening situations.
  • Specific patient comorbidities (kidney/cardiac pathology, hyperkalemia) and drug interactions elevate risk.

Conclusions:

  • Physicians must be aware of TMP/SMX risks, especially in vulnerable patients.
  • Strategies to mitigate adverse events should be implemented.
  • Alternative, safer antibiotics are recommended when appropriate.

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