Evaluation of hyperkalemia associated with intravenous co-trimoxazole in hospitalized patients in Oman

Pharmacy Practice

  • Dalia Abdalaziz1Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University (SQU), Oman.
  • Ibrahim Al-Zakwani1Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University (SQU), Oman.
  • Aly Abdelrahman1Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University (SQU), Oman.
  • Ibrahim Hamdy2Physician Assistant Program, Morsani College of Medicine, University of South Florida, US.
  • Yousuf AlSuleimani1Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University (SQU), Oman.

Volume 22 Issue 3 Pages 1-9

DOI: 10.18549/PharmPract.2024.3.3004

Abstract

Co-trimoxazole is a combination of two antimicrobial drugs, (trimethoprim and sulfamethoxazole), that are used to treat a wide variety of infections such as urinary tract infection, pneumocystis pneumonia and traveler’s diarrhea. Hyperkalemia is a life-threatening electrolyte disturbance. Objectives: This study aimed to determine the incidence of hyperkalemia and its risk factors among hospitalized patients receiving intravenous co-trimoxazole at Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective observational study included patients that were prescribed intravenous co-trimoxazole and identified using a computerized pharmacy system between January 2010 and December 2020. Patients’ demographic and clinical characteristics were retrieved from their electronic medical records. The data were analyzed using descriptive and inferential statistical tests. Results: A total of 420 patients participated in this study. The median age of the patients was 51 (35-65) years and 55.5% were male. Hyperkalemia associated with co-trimoxazole was observed in (40.2%) of the patients. Around (44.2%) of patients who experienced hyperkalemia received a high dose of co-trimoxazole (15-20 mg/kg). Hyperkalemia occurred after the 5th day of co-trimoxazole treatment. Logistic regression analysis showed no relationship between hyperkalemia and age (adjusted odds ratio (AOR) 1.054, p=0.84), sex (AOR 1.167; p=0.471), dose (AOR 0.779; p=0.251), or use of concomitant medications (angiotensin-converting inhibitors, AOR 1.054, p=0.84; angiotensin receptor blockers, AOR 0.564; p=0.734; β-blockers, AOR 0.986; p=0.963; potassium supplements, AOR 0.59; p=0.175; nonsteroidal anti-inflammatory drugs, AOR 0.842, p=0.684; spironolactone AOR 0.748, p=0.629; heparin AOR 0.822, p=0.382; calcineurin inhibitor, AOR 1.537, p=0.406). Conclusion: Co-trimoxazole use was associated with a high incidence of hyperkalemia in this group of patients. No association between hyperkalemia and risk factors was observed. Serum potassium levels should be closely monitored, especially in the first week of co-trimoxazole treatment, to prevent the incidence of hyperkalemia, and clinical staff should adhere to serum monitoring guidelines.

Keywords

  • co-trimoxazole
  • intravenous
  • hyperkalemia
Pharmacy Practice

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