Title : Antibiotic induces barter syndrome- A systematic review
Abstract:
Background
Bartter syndrome encompasses salt-losing tubulopathies characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperreninemic hyperaldosteronism with normal blood pressure.
Acquired Bartter or Bartter-like syndrome (BLS) is commonly associated with the use of diuretics and antibiotics such as capreomycin, netilmicin, colistin, amphotericin B, cyclosporine, cisplatin. This systematic review was done to understand the time of occurrence of Bartter syndrome post inciting drug and gain knowledge regarding its progression and management.
Methods
A systematic search following the Preferred Reporting Items for Systematic reviews and meta-analyses (PRISMA) guidelines was performed in Pubmed, Google Scholar, Embase, medRxiv, and bioRxiv. All case reports, case series, and review articles published in literature from 1986 till March 2022 were screened. Thirty-nine cases were finally included for the review.
Results
Among the 39 cases, the mean age of presentation was 36yrs (SD: 19.8yrs, range 7-92yrs), with a Male: Female ratio of 1:2.7. The most common antimicrobial causing BLS was Aminoglycosides (60%), followed by colistin (32.5%), among the aminoglycosides -Gentamicin was most commonly implicated(62.5%), followed by Streptomycin and capreomycin (12.5% each), Amikacin, netilmicin, and tobramycin(4.1% each). The time of presentation after inciting antibiotic was a median of 8 days (IQR 6-23days).
All cases presented with metabolic alkalosis with a mean pH of 7.49(SD: 0.038, Range: 7.43 – 7.60), and a mean bicarbonate level of 32.9(SD: 4.70). Presenting features of distal tubulopathy was in the form of polyuria, hypokalemia (100%, mean: 2.37meq/L), hypomagnesemia (85%) and hypocalcemia (77.1%), hypercalciuria (51.85%), and urinary potassium loss in the form of raised 24 hr urinary loss or spot potassium/creat ratio or raised Transtubular potassium gradient evident in all the cases(n=39,100%).
All the cases were managed with electrolyte supplementation while a few cases with refractory hypokalemia were given spironolactone and NSAID. The median time for resolution of Bartter-like syndrome was 13.5days (IQR: 6-30 days).
Conclusions
Bartter-like syndrome (BLS), although a rare entity should be suspected in patients presenting with features of salt-losing tubulopathy on antimicrobials. The most common drug class implicated is the aminoglycosides( Gentamicin> Streptomycin, Capreomycin). Discontinuation of the inciting drug leads to complete reversal of the state.
