Intravenous flucloxacillin treatment is associated with a high incidence of hypokalaemia

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Abstract

Intravenous flucloxacillin is one of the most frequently used high-dose penicillin therapies in hospitalized patients, forming the cornerstone treatment of invasive Staphylococcus aureus infection. Being a nonreabsorbable anion, flucloxacillin has been suggested to cause hypokalaemia, although the frequency and magnitude of this unwanted effect is unknown. In a retrospective cohort, we investigated the incidence and extent of hypokalaemia after initiation of intravenous flucloxacillin or ceftriaxone therapy. In total, 77 patients receiving flucloxacillin (62% male, mean age 70.5 years) and 84 patients receiving ceftriaxone (46% male, mean age 70.8 years) were included. Hypokalaemia occurred significantly more often in patients receiving flucloxacillin than ceftriaxone (42% vs 14%, p < 10−4). Moreover, follow-up potassium levels were significantly lower during flucloxacillin therapy. In general, women were more prone to develop hypokalaemia than men. In conclusion, intravenous flucloxacillin use is associated with a striking incidence of hypokalaemia. Therefore, standardized potassium measurements are necessary.

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van der Heijden, C. D. C. C., Duizer, M. L., Fleuren, H. W. H. A., Veldman, B. A., Sprong, T., Dofferhoff, A. T. S. M., & Kramers, C. (2019). Intravenous flucloxacillin treatment is associated with a high incidence of hypokalaemia. British Journal of Clinical Pharmacology, 85(12), 2886–2890. https://doi.org/10.1111/bcp.13969

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