Renal Impairment Associated With Trimethoprim-Sulfamethoxazole Use in the Pediatric Population

Caroline M Sierra; Yen Tran; Lacey Oana; Khaled Bahjri

doi:10.5863/1551-6776-27.7.663

Renal Impairment Associated With Trimethoprim-Sulfamethoxazole Use in the Pediatric Population

J Pediatr Pharmacol Ther. 2022;27(7):663-668. doi: 10.5863/1551-6776-27.7.663. Epub 2022 Sep 26.

Authors

Caroline M Sierra¹, Yen Tran², Lacey Oana³, Khaled Bahjri⁴

Affiliations

¹ Department of Pharmacy Practice (CS), Loma Linda University School of Pharmacy, Loma Linda University, Loma Linda, CA.
² CVS Pharmacy (YT), Corona, CA.
³ Kaiser Permanente Riverside Medical Center Inpatient Pharmacy (LO), Riverside, CA.
⁴ Department of Pharmaceutical and Administrative Sciences (KB), Loma Linda University School of Pharmacy, Loma Linda, CA.

Abstract

Objective: Limited studies describe acute kidney injury (AKI) in children receiving trimethoprimsulfamethoxazole (SXT). The primary objective of this study was to describe AKI with SXT use in pediatric patients. Secondary objectives included describing the incidence of hyperkalemia and blood dyscrasias with SXT use.

Methods: In this retrospective, single-center observational study, inpatient electronic medical records were reviewed for patients younger than 18 years of age who received at least 5 days of SXT for treatment of a bacterial infection. Patients were excluded if serum creatinine data prior to and after initiation of SXT were unavailable, they had AKI or were on hemodialysis prior to SXT initiation, or they were admitted to an oncology unit.

Results: Of 98 patients who met inclusion criteria, 24 (24.5%) experienced stage I AKI and 16 (16.3%) experienced stage II or III AKI. The mean treatment duration with SXT at time of AKI development was 5.9 days. Coadministration of SXT with other nephrotoxic medications increased the risk of development of AKI (OR, 1.7; 95% CI, 1.2-2.4). Hyperkalemia was noted in 29 patients (29.6%), anemia in 39 patients (39.8%), thrombocytopenia in 30 (30.6%), and neutropenia in 39 (39.8%).

Conclusions: Changes in renal function suggestive of AKI occur frequently in pediatric patients receiving at least 5 days of treatment with SXT, particularly when using serum creatinine as a marker of AKI. In contrast, when using urine output rather than serum creatinine, the incidence is much lower and may be more reflective of a true change in renal function. Coadministration of nephrotoxic agents increases the risk of development of AKI. Anemia and hyperkalemia are common in patients receiving SXT and not associated with development of AKI. Further prospective study is warranted to validate these results.

Keywords: acute kidney injury; anemia; anti-bacterial agents; hyperkalemia; sulfamethoxazole-trimethoprim.

Grants and funding

Disclosures. The authors declare no financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.