Successful Use of Fludrocortisone for the Management of Trimethoprim–Sulfamethoxazole-Induced Hyperkalemia: A Case Series

Trimethoprim-sulfamethoxazole (TMP-SMX) is a widely used antibiotic for various infections but is often associated with hyperkalemia. In this case series, we evaluate the use of fludrocortisone (FCS), a mineralocorticoid receptor agonist, in managing TMP-SMX-induced hyperkalemia. Six patients treated with TMP-SMX for infectious indications developed hyperkalemia within 2-6 days of therapy initiation. The administration of FCS at doses ranging from 0.1 to 0.2 mg daily effectively stabilized potassium levels in all patients within 1-2 days, allowing most to continue the TMP-SMX treatment. These findings highlight the efficacy of FCS in mitigating TMP-SMX-induced potassium retention, thereby providing a safe and practical approach to maintaining essential antibiotic therapy.