Combination Antibiotic With Diuretic Increases Risk Of Sudden Death In Older Patients

Could the commonly prescribed antibiotic trimethoprim-sulfamethoxazole with the diuretic spironolactone, used to treat heart failure, double the risk of sudden death in older patients? New research published in the Canadian Medical Association Journal (CMAJ) examines the understudied dangers of the treatment.

Statistics showed that Trimethoprim-sulfamethoxazole is frequently prescribed for urinary tract infections, with more than 20 million prescriptions written each year in the United States, alone. While the added diuretic can help treat heart failure in some patients, researchers noted the potentially fatal consequences that can come with the drug's usage, including increased blood potassium levels.

Researchers conducted a 17-year study that involved 206,319 patients aged 66 years and older. During the study period, 11,968 of the participants died suddenly, while 328 of them died within 14 days after taking either trimethoprim-sulfamethoxazole, amoxicillin, ciprofloxacin, norfloxacin or nitrofurantoin. The sample of deaths showed that most of the participants were taking trimethoprim-sulfamethoxazole and older than 85, putting many of the older individuals at higher risk than those on the antibiotic amoxicillin.

"Sudden death during spironolactone treatment was more than twice as likely following a prescription for trimethoprim-sulfamethoxazole than for amoxicillin," said lead study author Dr. Tony Antoniou of the Li Ka Shing Knowledge Institute, St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, in a news release.

However, researchers concluded that more studies will be needed to help determine how other combined treatments may increase sudden death in older patients as well as other health issues.

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