同时服用三甲双胍-磺胺甲噁唑和阿莫西林的老年人在 30 天内发生地高辛中毒的风险:一项基于人群的队列研究。

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2024-07-01 Epub Date: 2024-06-24 DOI:10.1002/phar.2948
Flory T Muanda, Matthew A Weir, Fatemeh Ahmadi, Eric McArthur, Jessica M Sontrop, Sheikh S Abdullah, Brad L Urquhart, Hasti Sadeghi, Richard B Kim, Amit X Garg
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引用次数: 0

摘要

重要性:三甲双胍-磺胺甲噁唑(TMP-SMX)可能会增加地高辛的浓度,而地高辛是一种治疗指数较窄的药物。地高辛浓度的微小变化都可能使患者面临中毒风险:目的:分析服用地高辛的老年人同时服用 TMP-SMX 与同时服用阿莫西林后发生地高辛中毒的风险:加拿大安大略省基于人群的回顾性队列研究(2002-2020 年),使用关联的医疗保健数据。参与者包括 47961 名服用地高辛的老年人(58% 为女性;中位年龄为 80 岁[四分位数间距为 74-86] ),他们新近接受了 TMP-SMX 治疗(n = 10273),而新近接受阿莫西林治疗者(n = 37688):主要结果和测量指标:主要结果是抗生素处方后 30 天内出现地高辛中毒的住院情况(即入院或急诊就诊)。使用倾向得分的逆治疗概率加权来平衡比较组的基线健康指标。加权风险比(RR)采用改良泊松回归法得出,加权风险差异(RD)采用二项回归法得出。伤害所需人数(NNH)的计算公式为 1/RD:结果:接受 TMP-SMX 治疗的患者中有 49/10,273 人(0.48%)出现地高辛中毒,而接受阿莫西林治疗的患者中有 32/37,688 人(0.08%)出现地高辛中毒(加权 RR,5.71 [95% 置信区间 (CI),3.19 至 10.24];加权 RD,0.39% [95% CI,0.25% 至 0.53%];NNH 256 [95% CI,233 至 400]):在服用地高辛的老年人中,联合处方 TMP-SMX 与阿莫西林相比,30 天内因地高辛中毒住院的风险高出近 6 倍,但绝对风险差异较低(0.4%)。医生应在临床适当时开具替代抗生素处方。如果 TMP-SMX 必须与地高辛合用(如果认为益处大于风险),则应根据个体情况减少地高辛的剂量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Thirty-day risk of digoxin toxicity among older adults co-prescribed trimethoprim-sulfamethoxazole versus amoxicillin: A population-based cohort study.

Importance: Trimethoprim-sulfamethoxazole (TMP-SMX) may increase digoxin concentration, a medication with a narrow therapeutic index. Small changes in digoxin concentration could predispose individuals to the risk of toxicity.

Objective: To characterize the risk of digoxin toxicity in older adults taking digoxin following co-prescription of TMP-SMX compared with co-prescription of amoxicillin.

Design, settings, and participants: Retrospective population-based cohort study in Ontario, Canada (2002-2020) using linked health care data. Participants comprised 47,961 older adults taking digoxin (58% women; median age 80 years [interquartile range 74-86]) who were newly treated with TMP-SMX (n = 10,273) compared with those newly treated with amoxicillin (n = 37,688).

Exposure: Co-prescription of TMP-SMX versus amoxicillin in older adults concurrently taking digoxin.

Main outcome and measure: The primary outcome was a hospital encounter (i.e., hospital admission or emergency department visit) with digoxin toxicity within 30 days of the antibiotic prescription. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline health. Weighted risk ratios (RR) were obtained using modified Poisson regression and weighted risk differences (RD) using binomial regression. The number needed to harm (NNH) was calculated as 1/RD.

Results: A hospital encounter with digoxin toxicity occurred in 49/10,273 (0.48%) patients treated with TMP-SMX versus 32/37,688 (0.08%) in those treated with amoxicillin (weighted RR, 5.71 [95% confidence interval (CI), 3.19 to 10.24]; weighted RD, 0.39% [95% CI, 0.25% to 0.53%]; NNH 256 [95% CI, 233 to 400]).

Conclusion and relevance: In older adults taking digoxin, the 30-day risk of a hospital encounter with digoxin toxicity was nearly 6 times higher in those co-prescribed TMP-SMX versus amoxicillin, although the absolute risk difference was low (0.4%). Physicians should prescribe an alternative antibiotic when clinically appropriate. If TMP-SMX must be co-prescribed with digoxin (if the benefit is believed to outweigh the risk), digoxin should be dose-reduced on an individual basis.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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