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The Risks of Using Trimethoprim/Sulfamethoxazole in Patients with Renal and Cardiac Compromise

Arlene F. HoffmanPrivate practice, San Francisco, CA; Department of Medicine and Surgery, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA.

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Tzu Lu LinSurgical Residency Program, Chino Valley Medical Center, Chino, CA.

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The purpose of this article is to familiarize physicians with the risks of prescribing trimethoprim/sulfamethoxazole (TMP/SMX) for patients who have kidney or cardiac pathology, have hyperkalemia, or take other interacting medications. Although TMP/SMX is a drug that is frequently used to treat skin and soft-tissue infections of the leg and foot, particularly if methicillin-resistant Staphylococcus aureus is identified, it is not an innocuous antibiotic. Literature documenting the many adverse effects of TMP/SMX is reviewed. A case history is presented illustrating the association of TMP/SMX with the development of a life-threatening situation. Ways of avoiding these adverse events are discussed, and the use of safer antibiotics is recommended.

Corresponding author: Arlene F. Hoffman, DPM, PhD, 2100 Webster St, Ste 202, San Francisco, CA 94115-2375. (E-mail: ArleneHoffman@AFHoffman.com)