The safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit

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dc.contributor.authorDurmus, Mefkure
dc.contributor.authorAydin, Davut
dc.contributor.authorUstaomer, Sena
dc.contributor.authorGuzel Karahan, Sena
dc.contributor.authorKucuk, Ahmet Oguzhan
dc.contributor.authorPehlivanlar Kucuk, Mehtap
dc.date.accessioned2026-04-04T13:33:10Z
dc.date.available2026-04-04T13:33:10Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground Trimethoprim-sulfamethoxazole (TMP-SMX) has been used clinically against many gram-positive and gram-negative bacteria, Pneumocystis, and certain protozoa. Beside its beneficial effects, it has many adverse reactions such as hyperkalemia, aplastic anemia, fulminant hepatic necrosis, hematological and neurological toxicity. Evaluation of TMP-SMX-related adverse reactions in intensive care unit (ICU) patients who generally with polipharmacy is lacking. We aimed to identify TMP-SMX-related adverse effects associated with mortality, and to determine independent predictors of this outcome, and factors associated with adverse reactions in critically ill patients who generally with polypharmacy undergoing TMP-SMX therapy. Methods This retrospective observational cohort study was conducted in a 16-bed adult medical ICU in T & uuml;rkiye. To assess the impact of various factors on TMP-SMX-related adverse reactions, patients were categorized into two independent groups based on the presence or absence of adverse effects. Additionally, to analyze changes in laboratory parameters associated with TMP-SMX therapy, paired comparisons were made between pre-therapy and post-therapy values within the same patients. Statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 23.0. Results Serum creatinin (sCr) elevation, AST elevation, hyperbilirubinemia, thrombocytopenia, and metabolic acidosis were significantly associated with mortality, also sCr elevation was found to be an independent risk factor for mortality. Any of drugs or diseases were increased the risk of hyperkalemia concomitant TMP-SMX. ALT elevation were significantly associated with concomitantly teicoplanin. Endocrinologic disease or respiratory causes of ICU admission were found independent risk factors for AST elevation or acidosis respectively. Thrombocytopenia was associated with concomitantly colistin-echinocandin combination. Cardiovascular diseases concomitant TMP-SMX were found to be an independent risk factor for serum creatinin (sCr) elevation. There was no relationship between sCr elevation and TMP-SMX concomitantly colistimethate. Conclusions Physicians should pay attention when prescribing TMP-SMX to patients with cardiovascular diseases. Teicoplanin, colistin-echinocandin, piperacillin tazobactam and acyclovir should be administered carefully concomitantly TMP-SMX regarding liver enzyme elevation, thrombocytopenia and hyponatremia respectively.
dc.identifier.doi10.1186/s12879-025-12085-w
dc.identifier.issn1471-2334
dc.identifier.issue1
dc.identifier.orcid0000-0002-8701-3802
dc.identifier.orcid0000-0003-0818-2665
dc.identifier.orcid0000-0002-6993-0519
dc.identifier.pmid41299287
dc.identifier.scopus2-s2.0-105023050101
dc.identifier.scopusqualityQ2
dc.identifier.urihttps://doi.org/10.1186/s12879-025-12085-w
dc.identifier.urihttps://hdl.handle.net/11616/108978
dc.identifier.volume25
dc.identifier.wosWOS:001626499100007
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherBmc
dc.relation.ispartofBmc Infectious Diseases
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectTrimethoprim-sulfamethoxazole
dc.subjectIntensive care unit
dc.subjectRespiratory infections
dc.subjectPneumocystis jirovecii pneumonia
dc.subjectAdverse reaction
dc.subjectHyperkalemia
dc.titleThe safety profile of trimethoprim-sulfamethoxazole regarding concomitant other drugs: a comparative analysis of adverse effects in a tertiary level adult intensive care unit
dc.typeArticle

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