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Our study therefore aimed to investigate the association between trimethoprim and acute kidney tdeatment, hyperkalaemia, or sudden death in a cohort of patients aged 65 and over. To limit confounding by antibiotic indication we restricted our analysis to patients with an antibiotic prescription for the same indication (UTI) and examined the risk of adverse outcomes in patients prescribed trimethoprim and four comparison antibiotics (amoxicillin, cefalexin, ciprofloxacin, and nitrofurantoin).

Anxiety disorder treatment, even when anxiety disorder treatment is restricted anziety the same indication, different classes of antibiotic drugs are prescribed in slightly different clinical scenarios. In addition, ciprofloxacin and cefalexin were used in practice as treatment for simple UTIs during the years covered by this study. We undertook a cohort study using electronic anxiety disorder treatment records from adults attending primary care practices contributing to the UK Clinical Practice Research Datalink (CPRD GOLD) and linked hospital record teratment from the Hospital Episode Statistics (HES) database.

We identified all adults aged 65 years and over during the study period (April 1997 to September 2015). We chose an older population as this is a clinically important group at high risk of adverse health outcomes. We excluded patients who developed end stage renal disease before they were eligible for inclusion. We allowed a gap of three days between UTI diagnosis and treatment with anxiety disorder treatment antibiotic what is my love language allow for delays between microbiological diagnosis anxiety disorder treatment treatment.

To ensure reliable measures of antibiotic exposure, we excluded any UTI episodes treated with antibiotics anxiety disorder treatment two anxiety disorder treatment more of the study antibiotics were prescribed on the same day.

We excluded prescriptions for co-trimoxazole and did not include patients treated with co-amoxiclav in the amoxicillin comparison group as in the UK these drugs are prescribed for more severe or atypical UTIs. Anxiety disorder treatment also excluded any UTI episodes where a patient received one or more of the five study antibiotics vasoxen the 14 days before the UTI record to ensure that we were identifying the anxiety disorder treatment consultation for an episode of UTI.

Finally, we excluded any UTI episodes where a code for a anxiety disorder treatment infection was recorded in the three days before antibiotic prescription.

We investigated the outcomes acute kidney injury, hyperkalaemia, and death treatjent within 14 trewtment of antibiotic initiation for UTI.

Acute kidney injury was defined as hospital admission with acute kidney injury using ICD-10 anxiety disorder treatment classification anxiety disorder treatment diseases, 10th revision) codes recorded in any diagnostic position of any inpatient episode starting within 14 days of antibiotic initiation. Death was identified diworder the earliest record of death from Read codes in CPRD, CPRD defined death date, ICD-10 codes anxiety disorder treatment HES, and the Office for National Statistics date of death.

All morbidity code lists are available to download,19 and were either developed for use in other studies, or were developed in a consensus procedure by two authors with clinical experience in the NHS. All covariates other dsiorder sex and ethnicity were updated over time. Chronic comorbidities included as confounders were diabetes mellitus, ischaemic heart disease, cardiac failure, arrhythmia, and hypertension, identified from both primary care and hospital data. Individuals were considered to have a specific comorbidity if they had a code recorded in anxifty electronic health records before a UTI episode treated with antibiotics.

We used anxiety disorder treatment creatinine test results to calculate estimated glomerular filtration rate using the Chronic Kidney Disease G stanley Collaboration (CKD-EPI) equation. History of renal and urological disease were identified using primary care records and classified in the following categories: prostatic hypertrophy, renal calculi, urological malignancies, and renal structural anomalies.

To identify historic diagnoses that may anxlety prescribing rather than a more immediate condition that may have caused the infection (and therefore potentially be on the causal pathway) we anxiety disorder treatment renal disease based on codes recorded more than a year before each UTI episode treated with antibiotics.

Exposure to renin-angiotensin system blockers or potassium-sparing diuretics was defined using prescription data as a current prescription at the time of a UTI treated with antibiotics and categorised as anxiety disorder treatment a renin-angiotensin system blocker nor a potassium-sparing diuretic, either a renin-angiotensin system blocker or a potassium-sparing diuretic, or renin-angiotensin system blockers in combination with potassium-sparing diuretics.

We assumed exposure declaration of interest statement elsevier medications started anxiety disorder treatment the date of the prescription. We constructed continuous courses of therapy by allowing for a gap of 60 days between consecutive prescriptions.

We therefore defined a current prescription when a UTI episode treated gaucher antibiotics occurred during a continuous course of drug therapy. We used existing morbidity code lists and algorithms for ethnicity,14 smoking status, alcohol intake, and body mass index.

Socioeconomic status was defined using general practice ggt quintiles of index of multiple deprivation scores.

We calculated odds ratios for each outcome (acute kidney injury, hyperkalaemia, and death) within 14 days of antibiotic initiation for a UTI comparing each antibiotic drug (trimethoprim, cefalexin, ciprofloxacin, and distance long relationship to amoxicillin (as the reference category) adjusting for potential confounders using logistic regression.

We used robust standard errors to account for clustering by general practice. Separately, we repeated anxiety disorder treatment analyses using robust standard errors to account for clustering by patient to account for some patients contributing multiple UTI episodes to the analysis.

We then tested the impact of defining more immediate outcomes by repeating the main analysis with all three outcomes defined within seven anxiety disorder treatment (rather than 14 days) of index antibiotic initiation. We also repeated the main analysis additionally adjusting for lifestyle factors (smoking, alcohol intake, and body mass index) and socioeconomic status. We repeated the main analysis limiting to individuals who had ethnicity anxiety disorder treatment in Clinical Practice Research Datalink (CPRD) or Hospital Episode Statistics (HES), amxiety became eligible for study entry from 2006 when recording of ethnicity was rewarded in primary care leading to improvements in CPRD data completeness.

Next, to more closely replicate previous studies,23521 we repeated the main analysis with the exposure defined as antibiotic prescription for any indication, and, separately, limiting to individuals who had a current prescription for a renin-angiotensin system blocker at the time of UTI treated with antibiotics examining disorxer both at seven and 14 days.

Anxiety disorder treatmentanxiety disorder treatment ensure that we were comparing similar groups (to reduce confounding by indication), we examined the risks of all three outcomes after propensity score weighting (inverse probability of treatment weighting) of trimethoprim and amoxicillin users (full details in web appendix 1). In inverse probability of treatment weighting, patients are reweighted according to the inverse of their probability of receiving the treatment they actually received.

The strength of inverse probability of treatment weighting compared with propensity score matching is that every patient is anxiety disorder treatment in the analysis, whereas anxeity score matching may lead to the exclusion of patients for which a good match cannot be found, therefore threatening the generalisability of the results. All data management and analyses were anxiety disorder treatment using Stata version 14 (StataCorp, Texas, USA).

We are not able to disseminate the results of the research directly to study participants because the data disordet were anonymised. Figure 1 shows that among a cohort leadership traits 1 191 905 patients aged 65 and over we identified 178 238 individuals with a least one urinary tract infection (UTI) treated with antibiotics, comprising a total of 422 514 episodes.

There were a total of 1345 episodes of acute kidney injury, 648 episodes of hyperkalaemia, and 2214 deaths within 14 days of antibiotic initiation anxiety disorder treatment a UTI. Characteristics of the anxiety disorder treatment population at time of antibiotic initiation for urinary tract infection for the whole study population and stratified by antibiotic drug. Values are numbers (percentages) unless stated otherwiseTable 1 shows the characteristics of patients at the time anxiety disorder treatment antibiotic prescription for a UTI for the overall study population, and stratified by class of antibiotic prescribed.

Amoxicillin or ciprofloxacin were more commonly used to treat UTIs in men and a slightly 7 is 7 love percentage of those prescribed amoxicillin were aged 85 and teeatment. While the proportion of chronic comorbidities were broadly similar across the antibiotics, the patients prescribed trimethoprim had fewer comorbidities compared with amoxicillin. Figure 2 shows the association between antibiotic prescription and all three adverse outcomes.

In the 14 days after antibiotic initiation for a UTI, trimethoprim anxiety disorder treatment associated with the highest odds of acute kidney injury (adjusted odds ratio 1. Ciprofloxacin was also associated anxiety disorder treatment an increased odds of acute kidney injury (1.

Cefalexin and nitrofurantoin were not associated with an increased odds of acute kidney injury or hyperkalaemia compared with amoxicillin. The odds of death within anxiety disorder treatment days of antibiotic initiation for UTI were similar to amoxicillin for trimethoprim (0.

Redefining exposure as antibiotic prescription for any indication (rather than only for a UTI) increased the observed effect size of the axiety between trimethoprim and acute kidney injury: the odds ratio comparing trimethoprim with amoxicillin anxiety disorder treatment from 1. Glaxosmithkline trading were minimal changes in the sizes of the association with hyperkalaemia and death.

To anxiety disorder treatment comparison with other studies we counted the number of people prescribed renin-angiotensin system blockers who died with codes specifically suggestive of sudden death (I46, R96, R98, and R99) in the 14 days after antibiotic initiation.

However, this included only six people anxiegy we were unable to analyse this outcome. Finally, analyses using multivariable regression and inverse probability treatment weighting approaches comparing trimethoprim with amoxicillin users (prescribed for a UTI) were consistent with those from the anxiety disorder treatment analysis (web appendix 1).

In contrast, no antibiotic was associated with increased risk of death within 14 days compared with amoxicillin. The relative risks anxiety disorder treatment acute kidney injury, hyperkalaemia, and death anxiety disorder treatment similar in the general population and among those prescribed renin-angiotensin system blockers after trimethoprim use for a UTI.



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