{"id":1408,"date":"2014-10-30T00:00:00","date_gmt":"2014-10-30T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/co-trimoxazole-and-sudden-death-in-patients-receiving-inhibitors-of-renin-angiotensin-system-population-based-study\/"},"modified":"2023-06-14T19:44:57","modified_gmt":"2023-06-14T23:44:57","slug":"co-trimoxazole-and-sudden-death-in-patients-receiving-inhibitors-of-renin-angiotensin-system-population-based-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/co-trimoxazole-and-sudden-death-in-patients-receiving-inhibitors-of-renin-angiotensin-system-population-based-study\/","title":{"rendered":"Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population-based study"},"content":{"rendered":"<p><strong>Objective<\/strong> &#x2014; To determine whether the prescription of co-trimoxazole with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is associated with sudden death. <\/p>\n<p><strong>Design<\/strong> &#x2014; Population-based, nested case-control study. <\/p>\n<p><strong>Setting<\/strong> &#x2014; Ontario, Canada, from April 1, 1994 to January 1, 2012. <\/p>\n<p><strong>Participants<\/strong> &#x2014; Ontario residents aged 66 years or older treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Within this group, cases were those who died of sudden death shortly after receiving an outpatient prescription for one of co-trimoxazole, amoxicillin, ciprofloxacin, norfloxacin or nitrofurantoin, antibiotics often prescribed for urinary tract infections. Each case was matched with up to 4 controls on age, sex, chronic kidney disease and diabetes. <\/p>\n<p><strong>Main Outcome Measure<\/strong> &#x2014; Odds ratio for the association between sudden death and exposure to each antibiotic relative to amoxicillin, after adjustment for predictors of sudden death using a disease risk index. <\/p>\n<p><strong>Results<\/strong> &#x2014; Of 39,879 patients who experienced sudden death, 1,027 occurred within 7 days of antibiotic exposure and were matched to 3,733 controls. Relative to amoxicillin, co-trimoxazole was associated with an increased risk of sudden death (adjusted odds ratio 1.38; 95% confidence interval 1.09 to 1.76). The risk was marginally higher at 14 days (adjusted odds ratio 1.54; 95% confidence interval 1.29 to 1.84). This corresponds to approximately 3 sudden deaths per 1,000 co-trimoxazole prescriptions. Ciprofloxacin (a known cause of QT interval prolongation) was 3 also associated with an increased risk of sudden death (adjusted odds ratio 1.29; 95% confidence interval 1.03 to 1.62), but no such risk was observed with nitrofurantoin or norfloxacin. <\/p>\n<p><strong>Conclusions<\/strong> &#x2014; In older patients receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, co-trimoxazole is associated with an increased risk of sudden death.&#xa0;The researchers&#xa0;speculate that unrecognized severe hyperkalemia underlies this finding. When appropriate, alternative antibiotics should be considered in such patients<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objective &#x2014; To determine whether the prescription of co-trimoxazole with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is associated with sudden death. Design &#x2014; Population-based, nested case-control study. Setting &#x2014; Ontario, Canada, from April 1, 1994 to January 1, 2012. Participants &#x2014; Ontario residents aged 66 years or older treated with an angiotensin-converting enzyme [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[56],"migration-helper-qa-sample-set":[],"class_list":["post-1408","journal_article","type-journal_article","status-publish","hentry","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Fralick M, Macdonald EM, Gomes T, Antoniou T, Hollands S, Mamdani MM, Juurlink DN. <em>BMJ.<\/em> 2014; 349:g6196. Epub 2014 Oct 30.","source_url":"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4214638\/","ices_scientist":[1252,1386,1325,1282],"site":[6733,6735],"research_program":[6746],"news_release":[7331],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"72B738A6-CD02-48BD-9573-7B268F86E960","sitecore_item_name":"Co-trimoxazole-and-sudden-death-in-patients-receiving-inhibitors-of-renin-angiotensin-system","sitecore_field_values":"{\n  \"__Valid from\": \"20170818T122435\",\n  \"Title\": \"Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population-based study\",\n  \"Short title\": \"Co-trimoxazole and sudden death\",\n  \"Summary\": \"To determine whether the prescription of co-trimoxazole with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is associated with sudden death.\",\n  \"Citation\": \"<p>Fralick M, Macdonald EM, Gomes T, Antoniou T, Hollands S, Mamdani MM, Juurlink DN. <em>BMJ.<\/em> 2014; 349:g6196. Epub 2014 Oct 30.<\/p>\",\n  \"Abstract\": \"<p><strong>Objective<\/strong> &mdash; To determine whether the prescription of co-trimoxazole with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is associated with sudden death. <\/p>n<p><strong>Design<\/strong> &mdash; Population-based, nested case-control study. <\/p>n<p><strong>Setting<\/strong> &mdash; Ontario, Canada, from April 1, 1994 to January 1, 2012. <\/p>n<p><strong>Participants<\/strong> &mdash; Ontario residents aged 66 years or older treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Within this group, cases were those who died of sudden death shortly after receiving an outpatient prescription for one of co-trimoxazole, amoxicillin, ciprofloxacin, norfloxacin or nitrofurantoin, antibiotics often prescribed for urinary tract infections. Each case was matched with up to 4 controls on age, sex, chronic kidney disease and diabetes. <\/p>n<p><strong>Main Outcome Measure<\/strong> &mdash; Odds ratio for the association between sudden death and exposure to each antibiotic relative to amoxicillin, after adjustment for predictors of sudden death using a disease risk index. <\/p>n<p><strong>Results<\/strong> &mdash; Of 39,879 patients who experienced sudden death, 1,027 occurred within 7 days of antibiotic exposure and were matched to 3,733 controls. Relative to amoxicillin, co-trimoxazole was associated with an increased risk of sudden death (adjusted odds ratio 1.38; 95% confidence interval 1.09 to 1.76). The risk was marginally higher at 14 days (adjusted odds ratio 1.54; 95% confidence interval 1.29 to 1.84). This corresponds to approximately 3 sudden deaths per 1,000 co-trimoxazole prescriptions. Ciprofloxacin (a known cause of QT interval prolongation) was 3 also associated with an increased risk of sudden death (adjusted odds ratio 1.29; 95% confidence interval 1.03 to 1.62), but no such risk was observed with nitrofurantoin or norfloxacin. <\/p>n<p><strong>Conclusions<\/strong> &mdash; In older patients receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, co-trimoxazole is associated with an increased risk of sudden death.&nbsp;The researchers&nbsp;speculate that unrecognized severe hyperkalemia underlies this finding. When appropriate, alternative antibiotics should be considered in such patients<\/p>n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4214638\/\" title=\"opens external link\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{8B171BCD-F63E-4950-9C0D-FA00417F685C}|{43CD54EE-583B-4D2D-BA6B-DAC3B29A9E23}|{D4620196-76F6-4AE4-9103-FB996B44FAC4}\",\n  \"Related Products\": \"<h2>News release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=336D50DF3B304774BF5124AF23300176&amp;_z=z\">Combination of popular antibiotic with blood pressure lowering drugs increases risk of sudden death by 40 to 50 per cent<\/a><\/h3>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}|{5B1AF319-EC9B-4BF0-A9CD-D066ABE49D71}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}|{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{1FA4634A-81DF-4A25-8739-98ABF3872B45}|{4FE84877-EBF5-4E0E-88AA-82F7AEB2DE79}|{F2F916BC-2EE9-4C65-BCAB-086ED6BB971A}|{5268F1B0-EB3E-4577-93DF-3C70C9399847}\",\n  \"Posted Date\": \"20141030T095700\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2014\/January\/Co-trimoxazole-and-sudden-death-in-patients-receiving-inhibitors-of-renin-angiotensin-system"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population-based study<\/title>\n<meta name=\"description\" content=\"Objective &#x2014; 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