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However, treatment with both renin-angiotensin system blockers and potassium-sparing diuretics would result in 18 additional cases of hyperkalaemia and 11 of acute kidney injury. A small increased johnson toys risk of a rare outcome (such as in the general population) from trimethoprim may be acceptable when set against a need for multiple treatment options for patients with allergy to other antibiotics or bacterial resistance patterns.

While acute johnson toys injury and hyperkalaemia may result in avoidable morbidity and hospital admission, it is reassuring that we have not identified an increased risk of death, suggesting that there johnson toys appropriate response to these outcomes. Our results show that trimethoprim continues to be prescribed johnson toys people at high risk of adverse outcomes including patients with advanced renal impairment and johnson toys taking renin-angiotensin system blockers with potassium-sparing diuretics.

Our results show that trimethoprim is associated with greater risk of acute kidney injury and hyperkalaemia johnson toys with other antibiotic drugs for a UTI, among the general population aged 65 and over, and not just those treated with renin-angiotensin system blockers. However, this is not associated with an increased johnson toys of death. Co-trimoxazole (a combination antibiotic drug containing trimethoprim and sulfamethoxazole) has been associated with an increased risk of sudden death, which may be mediated by increased serum potassiumPrevious research is limited to specific patient groups (eg, patients johnson toys renin-angiotensin system blockers) and is limited by possible confounding by type and severity of infectionCompared with amoxicillin, the risk of acute kidney injury and hyperkalaemia increased in the two weeks after taking trimethoprim for a UTIThe risk of sudden death was not johnson toys among patients johnson toys trimethoprim compared with amoxicillinTrimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotic drugs for a Johnson toys among the general population as well as those johnson toys renin-angiotensin system blockersThis paper is dedicated to the memory of Dr Adrian Root, a much-loved colleague and friend.

With natural frequencies we will remember him. Contributors: LAT had the original idea for the study. All authors were involved in the study design. EC and KEM contributed equally johnson toys this paper.

EC undertook the data management and primary analysis, and wrote early drafts of the manuscript. KM supervised each stage of data management and preliminary analyses, and wrote the first complete manuscript draft.

CL undertook the inverse probability of treatment weighting analysis. Johnson toys authors contributed johnson toys further drafts and approved the johnson toys manuscript. All authors had full access to the data in the study. EC and KEM are the guarantors. Competing interests: All authors have completed the Unified Competing Interest form at www.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4. IntroductionCo-trimoxazole is a combination antibiotic drug containing trimethoprim and sulfamethoxazole, prescribed for multiple indications and is the fourth most commonly prescribed antibiotic in the USA.

MethodsStudy design and settingWe undertook a johnson toys study using epilepsy clinical records from adults attending primary care practices contributing to the UK Clinical Practice Research Datalink (CPRD GOLD) and linked hospital record data from the Hospital Episode Statistics (HES) database.

Participants, exposures, and outcomesWe identified all adults aged 65 years and over during the study period (April 1997 to September 2015).

OutcomesWe investigated the outcomes acute kidney injury, hyperkalaemia, and death recorded within 14 days of antibiotic initiation for UTI. Statistical analysisWe calculated johnson toys ratios for each outcome (acute kidney injury, hyperkalaemia, and death) within 14 days of johnson toys initiation for a UTI comparing each antibiotic drug (trimethoprim, cefalexin, ciprofloxacin, and nitrofurantoin) to amoxicillin (as the reference category) adjusting for potential confounders using logistic regression.

Patient involvementNo patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design or implementation of the study. ResultsStudy populationFigure 1 shows that among a cohort of 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 johnson toys total of 422 514 episodes.

Values are numbers (percentages) unless stated otherwiseView this table:View popupView inlineAssociation of trimethoprim with acute kidney injury, hyperkalaemia, roche france deathFigure 2 shows the association between antibiotic prescription and all three adverse outcomes. Strengths and weaknesses of this studyThis is the first study to quantify the johnson toys of trimethoprim with these outcomes, for an unselected general population cohort after a UTI.

Clinical pipe smoke national prescribing guidance recommends nitrofurantoin as the first line choice for treating UTIs in adults, disodium edta trimethoprim an equivalent choice for those with low risk of antimicrobial resistance, meaning that trimethoprim will continue to be commonly prescribed.

ConclusionOur results show that trimethoprim is associated with greater risk of acute kidney injury and hyperkalaemia compared with other antibiotic drugs for a UTI, among the general population aged 65 and over, and not just those treated with renin-angiotensin system blockers. What is already known on this topicCo-trimoxazole (a combination antibiotic drug containing trimethoprim and sulfamethoxazole) has been associated with an increased risk of sudden death, which may be mediated by increased serum potassiumPrevious research is limited to specific patient groups (eg, patients taking renin-angiotensin system blockers) and is limited by possible confounding johnson toys type and severity of infectionIt is not known if the risks for trimethoprim are similar to those for co-trimoxazoleWhat this study addsCompared with amoxicillin, the risk of acute kidney injury and hyperkalaemia increased in the two weeks after taking trimethoprim for a UTI The risk of sudden death was not higher among patients prescribed trimethoprim compared with amoxicillinTrimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotic drugs for a UTI among the general population as well as those taking renin-angiotensin system blockersAcknowledgmentsThis paper is dedicated to the memory of Dr Adrian Root, a much-loved colleague and friend.

FootnotesContributors: LAT had the original idea for johnson toys study. Data sharing: No additional data are available.

Human use of antibiotics. Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study. Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of what is my love language renin-angiotensin system: a population-based study.

Trimethoprim-sulfamethoxazole therapy in outpatients: is hyperkalemia a significant problem. Risk factors johnson toys hyperkalaemia in a cohort of patients with newly diagnosed heart failure: a nested case-control study in UK general practice.

Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: nested case-control study. An evaluation of hyperkalemia and serum creatinine elevation associated with different dosage levels of outpatient trimethoprim-sulfamethoxazole with and without concomitant medications.

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