{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:39Z","timestamp":1783509279940,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>\n                    The purpose of this article is to familiarize physicians with the risks of prescribing trimethoprim\/sulfamethoxazole (TMP\/SMX) for patients who have kidney or cardiac pathology, have hyperkalemia, or take other interacting medications. Although TMP\/SMX is a drug that is frequently used to treat skin and soft-tissue infections of the leg and foot, particularly if methicillin-resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    is identified, it is not an innocuous antibiotic. Literature documenting the many adverse effects of TMP\/SMX is reviewed. A case history is presented illustrating the association of TMP\/SMX with the development of a life-threatening situation. Ways of avoiding these adverse events are discussed, and the use of safer antibiotics is recommended.\n                  <\/jats:p>","DOI":"10.7547\/21-080","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T12:17:37Z","timestamp":1666009057000},"source":"Crossref","is-referenced-by-count":4,"title":["The Risks of Using Trimethoprim\/Sulfamethoxazole in Patients with Renal and Cardiac Compromise"],"prefix":"10.3390","volume":"112","author":[{"given":"Arlene F.","family":"Hoffman","sequence":"first","affiliation":[{"name":"Private practice, San Francisco, CA; Department of Medicine and Surgery, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu Lu","family":"Lin","sequence":"additional","affiliation":[{"name":"Surgical Residency Program, Chino Valley Medical Center, Chino, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Oxford Handbook of Infectious Diseases and Microbiology","author":"T\u00f6r\u00f6k E","year":"2009","unstructured":"T\u00f6r\u00f6k E, Cooke FJ, Moran E: Oxford Handbook of Infectious Diseases and Microbiology, Oxford University Press, Oxford, England, 2009."},{"key":"B2","series-title":"Clin Infect Dis","first-page":"e18","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children","volume":"52","author":"Liu C","year":"2011","unstructured":"Liu C, Bayer A, Cosgrove SE, et al: Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 52: e18, 2011."},{"key":"B3","article-title":"Methicillin-resistant Staphylococcus aureus (MRSA) in adults: treatment of skin and soft tissue infections","author":"Lowy FD","unstructured":"Lowy FD: Methicillin-resistant Staphylococcus aureus (MRSA) in adults: treatment of skin and soft tissue infections. UpToDate. Available at: https:\/\/www.uptodate.com\/contents\/methicillin-resistant-staphylococcus-aureus-mrsa-in-adults-treatment-of-skin-and-soft-tissue-infections. Accessed August 29, 2020. Published 2020."},{"key":"B4","series-title":"Open Forum Infect Dis","first-page":"ofx232","article-title":"Sulfamethoxazole-trimethoprim (Cotrimoxazole) for skin and soft tissue infections including impetigo, cellulitis, and abscess","volume":"4","author":"Bowen AC","year":"2017","unstructured":"Bowen AC, Carapetis JR, Currie BJ, et al: Sulfamethoxazole-trimethoprim (Cotrimoxazole) for skin and soft tissue infections including impetigo, cellulitis, and abscess. Open Forum Infect Dis 4: ofx232, 2017."},{"key":"B5","series-title":"PLoS One","first-page":"e0224106","article-title":"Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs)","volume":"14","author":"Deconinck L","year":"2019","unstructured":"Deconinck L, Dinh A, Nich C, et al: Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs). PLoS One 14: e0224106, 2019."},{"key":"B6","series-title":"Handbook of Lower Extremity Infections","first-page":"323","article-title":"\u201cMethicillin Resistant Staphylococcus aureus (MRSA),\u201d","author":"Joseph WS","year":"2009","unstructured":"Joseph WS: \u201cMethicillin Resistant Staphylococcus aureus (MRSA),\u201d in Handbook of Lower Extremity Infections, 3rd Ed, p 323, Data Trace Publishing, Brooklandville, MD, 2009."},{"key":"B7","series-title":"Lancet","first-page":"394","article-title":"Deterioration in renal function in association with co-trimoxazole therapy","volume":"301","author":"Kalowski S","year":"1973","unstructured":"Kalowski S, Mathew T, Singh Nanra R, et al: Deterioration in renal function in association with co-trimoxazole therapy. Lancet 301: 394, 1973."},{"key":"B8","series-title":"J Urol","first-page":"802","article-title":"Effect of trimethoprim-sulfamethoxazole on the renal excretion of creatinine in man","volume":"114","author":"Berglund F","year":"1975","unstructured":"Berglund F, Killander J, Pompeius R: Effect of trimethoprim-sulfamethoxazole on the renal excretion of creatinine in man. J Urol 114: 802, 1975."},{"key":"B9","series-title":"Ther Drug Monit","first-page":"161","article-title":"Effect of trimethoprim on serum creatinine in healthy and chronic renal failure volunteers","volume":"9","author":"Myre SA","year":"1987","unstructured":"Myre SA, McCann J, First MR, et al: Effect of trimethoprim on serum creatinine in healthy and chronic renal failure volunteers. Ther Drug Monit 9: 161, 1987."},{"key":"B10","series-title":"Ann Pharmacother","first-page":"1618","article-title":"An evaluation of hyperkalemia and serum creatinine elevation associated with different dosage levels of outpatient trimethoprim-sulfamethoxazole with and without concomitant medications","volume":"47","author":"Gentry CA","year":"2013","unstructured":"Gentry CA, Nguyen AT: An evaluation of hyperkalemia and serum creatinine elevation associated with different dosage levels of outpatient trimethoprim-sulfamethoxazole with and without concomitant medications. Ann Pharmacother 47: 1618, 2013."},{"key":"B11","series-title":"Clin Microbiol Infect","first-page":"1651","article-title":"Evaluating the risk of hyperkalaemia and acute kidney injury with cotrimoxazole: a retrospective observational study","volume":"26","author":"Rajput J","year":"2020","unstructured":"Rajput J, Moore LS, Mughal N, et al: Evaluating the risk of hyperkalaemia and acute kidney injury with cotrimoxazole: a retrospective observational study. Clin Microbiol Infect 26: 1651, 2020."},{"key":"B12","series-title":"Ann Intern Med","first-page":"316","article-title":"Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole","volume":"124","author":"Alappan R","year":"1996","unstructured":"Alappan R, Perazella MA, Buller GK: Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med 124: 316, 1996."},{"key":"B13","series-title":"Ann Intern Med","first-page":"296","article-title":"Renal mechanism of trimethoprim-induced hyperkalemia","volume":"119","author":"Velazquez H","year":"1993","unstructured":"Velazquez H: Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med 119: 296, 1993."},{"key":"B14","series-title":"Infect Control Hosp Epidemiol","first-page":"431","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)","volume":"31","author":"Cohen SH","year":"2010","unstructured":"Cohen SH, Gerding DN, Johnson S, et al: Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 31: 431, 2010."},{"key":"B15","series-title":"J Emerg Med","first-page":"741","article-title":"Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL\u2013ED): a multicenter, prospective, observational study","volume":"55","author":"Peacock WF","year":"2018","unstructured":"Peacock WF, Rafique Z, Clark CL, et al: Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL\u2013ED): a multicenter, prospective, observational study. J Emerg Med 55: 741, 2018."},{"key":"B16","series-title":"Clin Infect Dis","first-page":"e10","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: update by the Infectious Diseases Society of America","volume":"59","author":"Stevens DL","year":"2014","unstructured":"Stevens DL, Bisno AL, Chambers HF, et al: Practice guidelines for the diagnosis and management of skin and soft tissue infections: update by the Infectious Diseases Society of America. Clin Infect Dis 59: e10, 2014."},{"key":"B17","series-title":"Am J Nephrol","first-page":"389","article-title":"Trimethoprim-sulfamethoxazole therapy in outpatients: is hyperkalemia a significant problem?","volume":"19","author":"Alappan R","year":"1999","unstructured":"Alappan R, Buller GK, Perazella MA: Trimethoprim-sulfamethoxazole therapy in outpatients: is hyperkalemia a significant problem? Am J Nephrol 19: 389, 1999."},{"key":"B18","series-title":"Eur J Clin Pharmacol","first-page":"233","article-title":"Sulphamethoxazole\/trimethoprim: pharmacokinetic studies in patients with chronic renal failure","volume":"4","author":"Baethke R","year":"1972","unstructured":"Baethke R, Golde G, Gahl G: Sulphamethoxazole\/trimethoprim: pharmacokinetic studies in patients with chronic renal failure. Eur J Clin Pharmacol 4: 233, 1972."},{"key":"B19","series-title":"Br J Clin Pharmacol","first-page":"701","article-title":"The effect of co-trimoxazole on serum creatinine","volume":"12","author":"Dijkmans B","year":"1981","unstructured":"Dijkmans B, Hooff J, Wolff F, et al: The effect of co-trimoxazole on serum creatinine. Br J Clin Pharmacol 12: 701, 1981."},{"key":"B20","series-title":"J Antimicrob Chemother","first-page":"1271","article-title":"Acute kidney injury associated with trimethoprim\/sulfamethoxazole","volume":"67","author":"Fraser TN","year":"2012","unstructured":"Fraser TN, Avellaneda AA, Graviss EA, et al: Acute kidney injury associated with trimethoprim\/sulfamethoxazole. J Antimicrob Chemother 67: 1271, 2012."},{"key":"B21","series-title":"J Intern Med","first-page":"247","article-title":"A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible?","volume":"246","author":"Andreev E","year":"1999","unstructured":"Andreev E, Koopman M, Arisz L: A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible? J Intern Med 246: 247, 1999."},{"key":"B22","series-title":"Postgrad Med J","first-page":"710","article-title":"A study of the pharmacokinetics of clindamycin in normal subjects and patients with chronic renal failure","volume":"50","author":"Eastwood JB","year":"1974","unstructured":"Eastwood JB, Gower PE: A study of the pharmacokinetics of clindamycin in normal subjects and patients with chronic renal failure. Postgrad Med J 50: 710, 1974."},{"key":"B23","series-title":"CMAJ","first-page":"1851","article-title":"Considerations when prescribing trimethoprim-sulfamethoxazole","volume":"183","author":"Ho JMW","year":"2011","unstructured":"Ho JMW, Juurlink DN: Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ 183: 1851, 2011."},{"key":"B24","series-title":"Antimicrob Agents Chemother","first-page":"2466","article-title":"Effects of moderate-dose versus high-dose trimethoprim on serum creatinine and creatinine clearance and adverse reactions","volume":"41","author":"Naderer O","year":"1997","unstructured":"Naderer O, Nafziger AN, Bertino JS: Effects of moderate-dose versus high-dose trimethoprim on serum creatinine and creatinine clearance and adverse reactions. Antimicrob Agents Chemother 41: 2466, 1997."},{"key":"B25","series-title":"Drug Metab Pharmacokinet","first-page":"103","article-title":"Quantitative analysis of elevation of serum creatinine via renal transporter inhibition by trimethoprim in healthy subjects using physiologically-based pharmacokinetic model","volume":"33","author":"Nakada T","year":"2018","unstructured":"Nakada T, Kudo T, Kume T, et al: Quantitative analysis of elevation of serum creatinine via renal transporter inhibition by trimethoprim in healthy subjects using physiologically-based pharmacokinetic model. Drug Metab Pharmacokinet 33: 103, 2018."},{"key":"B26","series-title":"DICP","first-page":"646","article-title":"Clinical use of trimethoprim\/sulfamethoxazole during renal dysfunction","volume":"23","author":"Paap CM","year":"1989","unstructured":"Paap CM, Nahata MC: Clinical use of trimethoprim\/sulfamethoxazole during renal dysfunction. DICP 23: 646, 1989."},{"key":"B27","series-title":"Rev Infect Dis","first-page":"566","article-title":"Pharmacokinetics of intravenous trimethoprim-sulfamethoxazole in children and adults with normal and impaired renal function","volume":"4","author":"Siber GR","year":"1982","unstructured":"Siber GR, Gorham CC, Ericson JF, et al: Pharmacokinetics of intravenous trimethoprim-sulfamethoxazole in children and adults with normal and impaired renal function. Rev Infect Dis 4: 566, 1982."},{"key":"B28","series-title":"Tex Heart Inst J","first-page":"40","article-title":"Hyperkalemia revisited","volume":"33","author":"Parham WA","year":"2006","unstructured":"Parham WA, Mehdirad AA Biermann KM, et al: Hyperkalemia revisited. Tex Heart Inst J 33: 40, 2006."},{"key":"B29","article-title":"Another reason to avoid overuse of trimethoprim\/sulfamethoxazole (TMP\/SMX)","author":"Joseph WS","unstructured":"Joseph WS: Another reason to avoid overuse of trimethoprim\/sulfamethoxazole (TMP\/SMX). Podiatry Today Blog. Available at: https:\/\/www.hmpgloballearningnetwork.com\/site\/podiatry\/blogged\/another-reason-avoid-overuse-trimethoprimsulfamethoxazole-tmpsmx. Published August 24, 2010."},{"key":"B30","series-title":"Arch Intern Med","first-page":"1045","article-title":"Trimethoprim-sulfamethoxazole induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study","volume":"170","author":"Antoniou T","year":"2010","unstructured":"Antoniou T, Gomes T, Juurlink DN, et al: Trimethoprim-sulfamethoxazole induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study. Arch Intern Med 170: 1045, 2010.31."},{"key":"B31","series-title":"Infect Immun","first-page":"62","article-title":"Profound alterations of intestinal microbiota following a single dose of clindamycin results in sustained susceptibility to Clostridium difficile\u2013induced colitis","volume":"80","author":"Buffie CG","year":"2012","unstructured":"Buffie CG, Jarchum I, Equinda M, et al: Profound alterations of intestinal microbiota following a single dose of clindamycin results in sustained susceptibility to Clostridium difficile\u2013induced colitis. Infect Immun 80: 62, 2012."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/112\/5\/21-080.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/112\/5\/21-080.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/112\/5\/21-080.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:18:55Z","timestamp":1783505935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/112\/5\/21080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":31,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.7547\/21-080","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}