{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T18:19:42Z","timestamp":1774376382562,"version":"3.50.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T00:00:00Z","timestamp":1589155200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T00:00:00Z","timestamp":1589155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Clin Pharm"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Background<\/jats:italic> Co-trimoxazole is an antibiotic combination used for the treatment of <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia, amongst others. Co-trimoxazole is known to increase serum potassium. For this reason, Dutch guidelines advise serum potassium monitoring in high-risk patients. <jats:italic>Objective<\/jats:italic> This study aimed to determine average serum potassium rise after administration of intravenous co-trimoxazole in hospitalized patients, compared to intravenous ceftriaxone. This study also aimed to determine adherence to Dutch guidelines by measuring the incidence of serum potassium monitoring in these patients. <jats:italic>Setting<\/jats:italic> Five departments of the Canisius Wilhelmina Hospital, a teaching hospital in Nijmegen, the Netherlands. <jats:italic>Method<\/jats:italic> Data was collected and compared from patients that received intravenous co-trimoxazole (n\u2009=\u200966) and intravenous ceftriaxone (n\u2009=\u2009132) in the period of November 2008\u2013November 2017. For each patient using co-trimoxazole, two patients using ceftriaxone were included in a paired fashion. Baseline and follow-up potassium were collected, if available. Additionally, it was tested if serum potassium was measured around the initiation of antibiotic therapy. <jats:italic>Main outcome measure<\/jats:italic> Changes in serum potassium where obtainable in 30 patients using cotrimoxazole and 40 patients using ceftriaxone. When compared to ceftriaxone, administration of intravenous co-trimoxazole was associated with a significant mean increase in serum potassium (+\u20090.55\u00a0mmol\/l, 95% CI 0.29\u20130.80, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). After correction for confounders (baseline potassium, estimated glomerular filtration rate 30 to &lt;\u200960, the presence of haematological malignancies and the usage of corticosteroids), this effect shrunk noticeably, but remained significant (+\u20090.28\u00a0mmol\/l, 95% CI 0.03\u20130.53, <jats:italic>p<\/jats:italic>\u2009=\u20090.031). <jats:italic>Results<\/jats:italic> The incidence of hyperkalemia at follow-up was 20% in the cotrimoxazole group, compared to 5% in the ceftriaxone group. Despite this, serum potassium was often not measured in patients using intravenous cotrimoxazole, being 76% at baseline and 55% in the period of 48\u2013120\u00a0h after antibiotic therapy initiation, compared to 87% and 34% in the ceftriaxone group respectively. <jats:italic>Conclusion<\/jats:italic> Adherence to Dutch guidelines was poor as serum potassium monitoring was often not performed. As intravenous co-trimoxazole usage is associated with a significant increase in mean serum potassium, monitoring is strongly recommended.<\/jats:p>","DOI":"10.1007\/s11096-020-01052-x","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T02:02:16Z","timestamp":1589162536000},"page":"965-971","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Co-trimoxazole induced hyperkalemia and potassium monitoring in hospitalized patients"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0697-1858","authenticated-orcid":false,"given":"Milan M. E. A.","family":"Plantaz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-3866","authenticated-orcid":false,"given":"Bart A. J.","family":"Veldman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne C.","family":"Esselink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3213-8173","authenticated-orcid":false,"given":"Hanneke W. H. A.","family":"Fleuren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5398-6414","authenticated-orcid":false,"given":"Cornelis","family":"Kramers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,11]]},"reference":[{"issue":"4","key":"1052_CR1","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1001\/archinte.163.4.402","volume":"163","author":"PA Masters","year":"2003","unstructured":"Masters PA, Obryan TA, Zurlo J, Miller DQ, Joshi N. Trimethoprim-sulfamethoxazole revisited. Arch Inter Med. 2003;163(4):402.","journal-title":"Arch Inter Med"},{"issue":"10","key":"1052_CR2","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1056\/NEJM199303113281006","volume":"328","author":"MJ Choi","year":"1993","unstructured":"Choi MJ, Fernandez PC, Patnaik A, Coupaye-Gerard B, D'Andrea D, Szerlip H, et al. Trimethoprim-induced hyperkalemia in a patient with AIDS. N Engl J Med. 1993;328(10):703\u20136.","journal-title":"N Engl J Med"},{"issue":"4","key":"1052_CR3","doi-asserted-by":"publisher","first-page":"296","DOI":"10.7326\/0003-4819-119-4-199308150-00008","volume":"119","author":"H Velazquez","year":"1993","unstructured":"Velazquez H, Perazella MA, Wright FS, Ellison DH. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med. 1993;119(4):296.","journal-title":"Ann Intern Med"},{"issue":"6","key":"1052_CR4","first-page":"487","volume":"92","author":"AJ Viera","year":"2015","unstructured":"Viera AJ, Wouk N. Potassium disorders: hypokalemia and hyperkalemia. Am Fam Physician. 2015;92(6):487\u201395.","journal-title":"Am Fam Physician"},{"issue":"3","key":"1052_CR5","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2165\/00002018-200022030-00006","volume":"22","author":"MA Perazella","year":"2000","unstructured":"Perazella MA. Trimethoprim-induced hyperkalaemia. Drug Saf. 2000;22(3):227\u201336.","journal-title":"Drug Saf"},{"key":"1052_CR6","doi-asserted-by":"publisher","first-page":"g6196","DOI":"10.1136\/bmj.g6196","volume":"349","author":"M Fralick","year":"2014","unstructured":"Fralick M, Macdonald EM, Gomes T, Antoniou T, Hollands S, Mamdani MM, et al. Co-trimoxazole and sudden death in patients receiving inhibitors of renin\u2013angiotensin system: population based study. BMJ. 2014;349:g6196.","journal-title":"BMJ"},{"key":"1052_CR7","unstructured":"Royal Dutch Pharmacists Association Knowledge Base. Co-trimoxazole. https:\/\/kennisbank.knmp.nl\/article\/Informatorium_Medicamentorum\/S5307.html. Accessed 8 Jan 2019."},{"key":"1052_CR8","unstructured":"Dutch Pharmacotherapeutic Compass. Co-trimoxazole. https:\/\/www.farmacotherapeutischkompas.nl\/bladeren\/preparaatteksten\/c\/cotrimoxazol. Accessed 8 Jan 2019."},{"key":"1052_CR9","unstructured":"The acute booklet. Hyperkalemia. https:\/\/www.hetacuteboekje.nl\/hoofdstuk\/acute_water-_en_elektrolytstoornissen\/hyperkaliemie.html. Accessed 4 Feb 2020."},{"issue":"8","key":"1052_CR10","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1111\/bcp.13263","volume":"83","author":"WY Chan","year":"2017","unstructured":"Chan WY, Clark AB, Wilson AM, Loke YK, TIPAC investigators. The effect of co-trimoxazole on serum potassium concentration: safety evaluation of a randomized controlled trial. Br J Clin Pharmacol. 2017;83(8):1808\u201314.","journal-title":"Br J Clin Pharmacol"}],"container-title":["International Journal of Clinical Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-020-01052-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11096-020-01052-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-020-01052-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T01:07:39Z","timestamp":1620695259000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11096-020-01052-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,11]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["1052"],"URL":"https:\/\/doi.org\/10.1007\/s11096-020-01052-x","relation":{},"ISSN":["2210-7703","2210-7711"],"issn-type":[{"value":"2210-7703","type":"print"},{"value":"2210-7711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,11]]},"assertion":[{"value":"11 May 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All authors of this manuscript declare that they have no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}