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. 2019 Dec;85(12):2886-2890.
doi: 10.1111/bcp.13969. Epub 2019 Jun 22.

Intravenous flucloxacillin treatment is associated with a high incidence of hypokalaemia

Charlotte D C C van der Heijden  1 , Marleen L Duizer  1 , Hanneke W H A Fleuren  2 , Bart A Veldman  1 , Tom Sprong  1 , Anton T S M Dofferhoff  1 , Cornelis Kramers  1   2   3
Affiliations

Intravenous flucloxacillin treatment is associated with a high incidence of hypokalaemia

Charlotte D C C van der Heijden et al. Br J Clin Pharmacol. 2019 Dec.

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.

Keywords: flucloxacillin, hypokalaemia, nonreabsorbable anion, penicillins.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Figure 1
Figure 1
Intravenous flucloxacillin treatment is associated with a high incidence of hypokalaemia. A, Hypokalaemia was more frequent in patients on flucloxacillin than ceftriaxone treatment. Most patients developing hypokalaemia were female. B, after treatment, serum potassium levels were lower in patients on flucloxacillin treatment than ceftriaxone treatment (mean, SD). C, Histogram showing the distribution of potassium levels during treatment and D, the change in potassium level during treatment. ∆ delta, defined as change from baseline to follow‐up; K+, potassium; ns, nonsignificant
See this image and copyright information in PMC

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