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  • Temple EM

Canadian Bactrim: The Deathbringer

The Article:

Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study. BMJ 2014;349:g6196 doi: 10.1136/bmj.g6196 (Published 30 October 2014)

The Idea:

Whether Bactrim (Trimethoprim/sulfamethoxazole) is associated with sudden death in patients that are also taking an ARB or ACE inhibitor.

The Study:

Population based nested case-control study using Ontario residents over 65 years old taking an ACE inhibitor or ARB and looking for incidents of sudden death within 7 days of taking either trimethoprim/sulfamethoxazole, amoxicillin, ciprofloxacin, norfloxacin or nitrofurantoin. These patients were matched to up to four controls from within the population matched for age, sex, CKD and DM status and the odds ratio for developing sudden death after taking each antibiotic was compared to amoxicillin.

The Findings:

Trimethoprim/sulfamethoxazole was associated with an increased odds ratio for developing sudden death in patients on an ARB or ACE inhibitor both 7 days after initiation of antibiotic therapy and when extending the period to 14 days. Ciprofloxicin was also associated with an increased odds ratio for sudden death within 7 days but this effect disappeared when looking at odds of sudden death within 14 days of starting an antibiotic.

The Takeaway:

Trimethoprim/sulfamethoxazole may be correlated with sudden death in older patients on an ACE inhibitor or ARB through an unclear mechanism (possibly through induction of hyperkalemia). In a patient taking one of these medications, it may warrant consideration of alternative antibiotics where possible.

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