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Primary care
Trimethoprim is associated with a greater risk of acute kidney injury and hyperkalaemia in older adults compared with other antibiotics used to treat UTIs
  1. Oghenekome Gbinigie
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliff Primary Care Building, Woodstock Road, Oxford, England
  1. Correspondence to Dr Oghenekome Gbinigie, University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Woodstock Road, Oxford, OX2 6GG.; oghenekome.gbinigie{at}

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Commentary on: Crellin E, Mansfield KE, Leyrat C, et al. Trimethoprim use for urinary tract infection and risk of adverse outcomes in older patients: cohort study. BMJ 2018;360:k341.


Urinary tract infection (UTI) is the most common bacterial infection in older adults.1 Trimethoprim is a first-line antibiotic prescribed in the UK for acuteuncomplicated UTI.2 Trimethoprim reduces potassium excretion in the distal nephron, which can cause elevated potassium levels.3 This is of particular importance in older adults, who are more likely to have comorbidities requiring prescription of additional medicines that may predispose them to hyperkalaemia, such as renin-angiotensin antagonists (RAA).


This was a cohort study using general practice data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data in adults aged 65 and above who had received a prescription for one of five different antibiotics (trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin or amoxicillin) within …

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