Antibiotic-induced Bartter-like syndrome: a systematic review
Megha Priyadarshi1, Saurav Sekhar Paul1, Sunit Sikdar1
1Department of Medicine, All India Institute of Medical Sciences, Teaching block 3rd floor, AIIMS, New Delhi, India.
The Journal of Antimicrobial Chemotherapy
|May 21, 2025
Summary
Acquired Bartter-like syndrome (ABLS) is a rare condition linked to certain antibiotics. Promptly stopping the causative drug and managing electrolytes leads to full recovery.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Bartter syndrome is a group of salt-losing tubulopathies.
- Acquired Bartter-like syndrome (ABLS) is often caused by diuretics and specific antibiotics like aminoglycosides, colistin, and amphotericin B.
Purpose of the Study:
- To investigate the onset timing of Bartter syndrome after drug exposure.
- To explore the progression and management of acquired Bartter-like syndrome.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searched databases included PubMed, Embase, medRxiv, and bioRxiv.
- Screened case reports, case series, and reviews published between 1986 and March 2022, including 43 cases.
Main Results:
- Gentamicin (41.8%) and colistin (32.5%) were the most common antimicrobials linked to ABLS.
- Common symptoms included paraesthesias and carpopedal spasms, though 32.5% were asymptomatic.
- Key lab findings were 100% hypokalaemia and hypomagnesaemia, 97.2% metabolic alkalosis, and 92.5% hypocalcaemia, with normal serum creatinine.
Conclusions:
- ABLS should be suspected in patients on antimicrobials with salt-losing tubulopathy.
- Aminoglycosides are the most frequent culprits.
- Cessation of the offending drug and electrolyte management ensure complete recovery.
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