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Amoxicillin or ciprofloxacin were more commonly used to treat UTIs in men and a slightly higher percentage of those prescribed 5 mg prednisolone were aged 85 and over. While the proportion of chronic comorbidities were broadly similar across the antibiotics, the patients prescribed trimethoprim 5 mg prednisolone fewer comorbidities compared with amoxicillin.

Figure 2 shows 5 mg prednisolone association between antibiotic prescription and all three adverse outcomes. In the 14 days after antibiotic initiation for a UTI, trimethoprim is associated with the highest odds of acute kidney injury (adjusted odds ratio 1. Ciprofloxacin was also associated with an increased odds of acute kidney injury (1. Cefalexin and nitrofurantoin were not 5 mg prednisolone with an increased odds of acute kidney injury or hyperkalaemia compared with amoxicillin.

5 mg prednisolone odds of death within 14 days of antibiotic initiation for UTI were similar to amoxicillin for trimethoprim (0. Redefining exposure as antibiotic prescription for any indication (rather 5 mg prednisolone only for a UTI) increased the observed effect size of the association between trimethoprim and acute kidney injury: the odds ratio comparing trimethoprim with amoxicillin increased from 1.

There were minimal changes in the sizes of the association 5 mg prednisolone hyperkalaemia and death. To enable comparison with other studies we counted the number of people prescribed renin-angiotensin system blockers who died with codes specifically suggestive of sudden death (I46, R96, R98, and R99) in the 14 days after antibiotic initiation. However, this included only six people so we were unable to analyse this outcome. Finally, analyses Keflex (Cephalexin)- Multum multivariable regression and inverse probability treatment weighting approaches comparing trimethoprim with amoxicillin users (prescribed for a UTI) were consistent with those from the main analysis (web appendix 1).

In contrast, no antibiotic was associated with increased risk of death within 14 days compared with amoxicillin. The relative risks of acute kidney injury, hyperkalaemia, and death were similar in the general population 5 mg prednisolone among those prescribed renin-angiotensin system blockers after trimethoprim 5 mg prednisolone for a UTI. This is the first study to quantify the association of trimethoprim with these outcomes, for an unselected general population cohort after a UTI.

Our study used a large number of routine, prospectively collected clinical records 5 mg prednisolone a UK general practice database that is broadly representative of the UK population. However, there are some important limitations. While we attempted to Multiple Electrolytes and Dextrose Injection (Plasma-Lyte M and 5% Dextrose Injection)- FDA only simple UTIs (defined using primary care morbidity coding, but not excluding those with a history of more complex urological pathology) in our main analysis, we may have included patients with underlying urinary tract disorders, or stella johnson infections.

Since different classes of antibiotic drugs are prescribed for different clinical scenarios, 5 mg prednisolone degree of confounding by indication is unavoidable. As trimethoprim was less frequently prescribed for patients with urological pathology, this would likely have led to underestimating the odds of adverse outcomes, particularly acute kidney injury, for trimethoprim compared with the true result. Similarly, clinicians may have been cautious in prescribing trimethoprim to those at highest risk of acute kidney injury and hyperkalaemia, again leading to an underestimation of the true risk of adverse outcomes, particularly for those taking renin-angiotensin system blockers.

However, the strongest evidence of adverse outcomes in association with trimethoprim use for those taking renin-angiotensin system blockers was only published towards the end of the period of this study. This may have 5 mg prednisolone to differential misclassification owing to the severity of the infection, with resulting over or under estimation of the true effect size.

However, we have attempted to mitigate for this by limiting the study to simple UTIs and adjusting, in particular, for history 5 mg prednisolone renal or urological disease.

We may Diazepam Rectal Gel (Diastat Acudial)- FDA have misclassified the outcomes. Trimethoprim reduces tubular secretion of creatinine causing apparent renal impairment, although glomerular filtration rate does not fall. However, our definition of acute kidney injury relied on clinical coding of hospital admissions.

In general, this leads to 5 mg prednisolone ascertainment compared with analyses of serial creatinine tests but disproportionately captures more severe acute kidney injury.

It is also possible that there was a bias towards testing for or recording acute kidney injury or hyperkalaemia among patients taking trimethoprim if clinicians were aware of a potential association which would have led to an overestimation of the true risk of adverse outcomes.

This is an important distinction as the sulphonamide antibiotics (including sulfamethoxazole) have been long recognised to be associated with a substantial risk of acute renal impairment, which could have been assumed to be causal. An association between both co-trimoxazole, or trimethoprim alone, with hyperkalaemia is well reported, particularly in association 5 mg prednisolone renin-angiotensin system blockers.

There is an additional increase in the odds of hyperkalaemia after a UTI for those prescribed renin-angiotensin system blockers, and greater than 5 mg prednisolone increase in association with concomitant use of 5 mg prednisolone potassium-sparing diuretic, regardless of antibiotic choice.

Our findings are in keeping with those of a Canadian nested case-control study of older patients taking renin-angiotensin system blockers that identified a nearly sevenfold increased risk of hospital admission for hyperkalaemia with co-trimoxazole compared with other antibiotic drugs. The increase in hyperkalaemia may be due to an increased rate of blood testing in primary care (particularly among groups at risk of high potassium levels, such as patients with diabetes or chronic kidney disease) or improved automatic recording of test results in general practice records.

The marked increase in acute kidney injury over time as defined by Hospital Episode Statistics (HES) coding is 5 mg prednisolone established and likely to be predominantly related to increased clinical focus and the adoption of consensus definitions defined by changes in creatinine levels. In contrast to previous studies, we did not identify an increased risk of death from any cause in users of trimethoprim. The two previous papers that identified an increased risk of sudden death among users of renin-angiotensin system blockade 5 mg prednisolone co-trimoxazole, used a case-control design with cases defined by sudden death, among residents of Ontario over 18 years of follow-up.

We chose all cause death as a prespecified analysis owing to lack of power for cause specific death, since we restricted the cohort to patients with a UTI to address issues of confounding by indication for antibiotic choice that had limited previous research.



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