ArticleBMJ (Clinical research ed.)2018
Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study.
Article in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
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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.
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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.
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Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Use of sensitivity analyses to assess uncontrolled confounding from unmeasured variables in observational, active comparator pharmacoepidemiologic studies: a systematic review.American journal of epidemiology · 2025Pooled it
- Risk of antimicrobial-associated organ injury among the older adults: a systematic review and meta-analysis.BMC geriatrics · 2021Pooled it
- Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2021Guideline
- Multiscale Free-Energy Methods for Protonation-Coupled Light-Responsive Binding of Ionizable Photoswitchable eDHFR Inhibitors.Journal of chemical information and modeling · 2026Article
- Diagnosis of urinary tract infection in the emergency department - a real infection or an alarming indication for comprehensive geriatric assessment? A retrospective follow-up study.The Journal of frailty & aging · 2026Article
- Safety of Fluoroquinolones and Cotrimoxazole in Urinary Tract Infections in Older Males.Open forum infectious diseases · 2026Article
- Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults.JAMA network open · 2025Article
- Silent Dangers in Elderly Pharmacotherapy: The Interplay of Polypharmacy, Multimorbidity, and Drug Interactions.Journal of evaluation in clinical practice · 2025Review
- Optimizing Prevention of Recurrent Urinary Tract Infections in Older Patients with Frailty.Drugs & aging · 2025Review
- Two novel trimethoprim resistance genes,Antimicrobial agents and chemotherapy · 2025Article
- Evaluating the agreement between sensitivity and primary analyses in observational studies using routinely collected healthcare data: a meta-epidemiology study.BMC medicine · 2025Article
- Trigger Warning: How Modern Diet, Lifestyle, and Environment Pull the Trigger on Autosomal Dominant Polycystic Kidney Disease Progression.Nutrients · 2024Review
- Recent Progress in Regulating the Activity of Enzymes with Photoswitchable Inhibitors.Molecules (Basel, Switzerland) · 2024Review
- Article
- Antibiotic-Associated Acute Kidney Injury Among Older Adults: A Case-Crossover Study.Clinical drug investigation · 2024Article
- Implementation of a Taxonomy-Based Framework for the Selection of Appropriate Drugs and Outcomes for Real-World Data Signal Detection Studies.Drug safety · 2024Review
- Treatment of MRSA Infection: Where are We?Current medicinal chemistry · 2024Review
- tICA-Metadynamics for Identifying Slow Dynamics in Membrane Permeation.Journal of chemical theory and computation · 2023Article
- Trimethoprim resistance in surface and wastewater is mediated by contrasting variants of the dfrB gene.The ISME journal · 2023Article
- Trimethoprim-sulfamethoxazole and the risk of a hospital encounter with hyperkalemia: a matched population-based cohort study.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo determine if trimethoprim use for urinary tract infection (UTI) is associated with an increased risk of acute kidney injury, hyperkalaemia, or sudden death in the general population.
designCohort study.
settingUK electronic primary care records from practices contributing to the Clinical Practice Research Datalink linked to the Hospital Episode Statistics database.
participantsAdults aged 65 and over with a prescription for trimethoprim, amoxicillin, cefalexin, ciprofloxacin, or nitrofurantoin prescribed up to three days after a primary care diagnosis of UTI between April 1997 and September 2015.
main outcome measuresThe outcomes were acute kidney injury, hyperkalaemia, and death within 14 days of a UTI treated with antibiotics.
resultsAmong a cohort of 1 191 905 patients aged 65 and over, 178 238 individuals were identified with at least one UTI treated with antibiotics, comprising a total of 422 514 episodes of UTIs treated with antibiotics. The odds of acute kidney injury in the 14 days following antibiotic initiation were higher following trimethoprim (adjusted odds ratio 1.72, 95% confidence interval 1.31 to 2.24) and ciprofloxacin (1.48, 1.03 to 2.13) compared with amoxicillin. The odds of hyperkalaemia in the 14 days following antibiotic initiation were only higher following trimethoprim (2.27, 1.49 to 3.45) compared with amoxicillin. However, the odds of death within the 14 days following antibiotic initiation were not higher with trimethoprim than with amoxicillin: in the whole population the adjusted odds ratio was 0.90 (95% confidence interval 0.76 to 1.07) while among users of renin-angiotensin system blockers the odds of death within 14 days of antibiotic initiation was 1.12 (0.80 to 1.57). The results suggest that, for 1000 UTIs treated with antibiotics among people 65 and over, treatment with trimethoprim instead of amoxicillin would result in one to two additional cases of hyperkalaemia and two admissions with acute kidney injury, regardless of renin-angiotensin system blockade. However, for people taking renin-angiotensin system blockers and spironolactone treatment with trimethoprim instead of amoxicillin there were 18 additional cases of hyperkalaemia and 11 admissions with acute kidney injury.
conclusionTrimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia compared with other antibiotics used to treat UTIs, but not a greater risk of death. The relative risk increase is similar across population groups, but the higher baseline risk among those taking renin-angiotensin system blockers and potassium-sparing diuretics translates into higher absolute risks of acute kidney injury and hyperkalaemia in these groups.
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