Evidence map›Paper›PMID 25359996›Full record

ArticleBMJ (Clinical research ed.)2014

Co-trimoxazole and sudden death in patients receiving inhibitors of renin-angiotensin system: population based study.

Michael Fralick, Erin M Macdonald, Tara Gomes, Tony Antoniou, Simon Hollands, Muhammad M Mamdani, David N Juurlink, Canadian Drug Safety and Effectiveness Research Network

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 2 pooled it
11.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 2 syntheses or guidelines pooled it, 101 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Review
  8. Article
  9. Article
  10. Article
  11. Review
  12. Review
  13. On the Treatment ofOpen forum infectious diseases · 2021
    Review
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. Article
  20. Applying the Infectious Diseases Literature to People who Inject Drugs.Infectious disease clinics of North America · 2020
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 3 countries.

Michael FralickDepartment of Internal Medicine, University of Toronto, Toronto, ON, Canada, M5G 2C4.
Erin M MacdonaldInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5.
Tara GomesInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada, M5B 1W8 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, M5T 3M7.
Tony AntoniouInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada, M5B 1W8 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, M5T 3M7 Department of Family and Community Medicine, St Michael's Hospital, Toronto.
Simon HollandsInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5.
Muhammad M MamdaniInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada, M5B 1W8 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, M5T 3M7 Applied Health Research Centre, St Michael's Hospital, Toronto King Saud University, Riyadh, Saudi Arabia.
David N JuurlinkInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada, M5N 4M5 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada, M5B 1W8 Sunnybrook Research Institute, Toronto, ON, Canada, M4N 3M5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, M5T 3M7 dnj@ices.on.ca.
Canadian Drug Safety and Effectiveness Research Network
Institute for Clinical Evaluative Sciences · CASt Michael's Hospital · GBSt Michaels Hospital · GBUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine whether the prescription of co-trimoxazole with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker is associated with sudden death.

designPopulation based nested case-control study.

settingOntario, Canada, from 1 April 1994 to 1 January 2012.

participantsOntario 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 measureOdds 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.

resultsOf 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.

conclusionsIn 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.

Indexed as

AgedAged, 80 and overAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnti-Infective Agents, UrinaryCase-Control StudiesDeath, SuddenDrug InteractionsDrug Therapy, CombinationFemaleHumansHyperkalemiaMaleOdds RatioOntarioRisk FactorsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAnti-Infective Agents, UrinaryTrimethoprim, Sulfamethoxazole Drug Combination

Identifiers

PMID25359996
PMCPMC4214638
OpenAlexW2111194699

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.