[新聞] Co-trimoxazole+抑制RAS藥 可能突然死亡
http://mulicia.pixnet.net/blog/post/30612979
http://www.bmj.com/content/349/bmj.g6196.long
Abstract
Objective To determine whether the prescription of co-trimoxazole with an
angiotensin converting enzyme inhibitor or angiotensin receptor blocker is
associated with sudden death.
Design Population based nested case-control study.
Setting Ontario, Canada, from 1 April 1994 to 1 January 2012.
Participants Ontario residents aged 66 years or older treated with an
angiotensin converting enzyme inhibitor or angiotensin receptor blocker. Cases
were those who died suddenly shortly after receiving an outpatient prescription
for one of co-trimoxazole, amoxicillin, ciprofloxacin, norfloxacin, or
nitrofurantoin. Each case was matched with up to four controls on age, sex,
chronic kidney disease, and diabetes.
Main outcome measure Odds ratio for the association between sudden death and
exposure to each antibiotic relative to amoxicillin, after adjustment for
predictors of sudden death according to a disease risk index.
Results Of 39 879 sudden deaths, 1027 occurred within seven days of exposure to
an antibiotic and were matched to 3733 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, 1.29 to 1.84). This corresponds to
approximately three sudden deaths within 14 days per 1000 co-trimoxazole
prescriptions. Ciprofloxacin (a known cause of QT interval prolongation) was
also associated with an increased risk of sudden death (adjusted odds ratio
1.29, 1.03 to 1.62), but no such risk was observed with nitrofurantoin or
norfloxacin.
Conclusions In older patients receiving angiotensin converting enzyme
inhibitors or angiotensin receptor blockers, co-trimoxazole is associated with
an increased risk of sudden death. Unrecognized severe hyperkalemia may
underlie this finding. When appropriate, alternative antibiotics should be
considered in such patients.
給End的人：
如有在服用ACEI或是ARB的病人，同時併服Co-trimoxazole有可能增加突然死亡的機率。
可能的話，建議改別的抗生素給病人服用。
--
※ 發信站: 批踢踢實業坊(ptt.cc), 來自: 61.230.204.251
※ 文章網址: http://www.ptt.cc/bbs/pharmacist/M.1419764484.A.E30.html
推
12/28 20:10, , 1F
12/28 20:10, 1F
推
12/30 00:07, , 2F
12/30 00:07, 2F
pharmacist 近期熱門文章
PTT職涯區 即時熱門文章