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Letters Co-trimoxazole and sudden death with RAS inhibitors

Authors’ reply to Scheper and Lijfering

BMJ 2014; 349 doi: (Published 18 November 2014) Cite this as: BMJ 2014;349:g6906
  1. Michael Fralick, internal medicine resident1,
  2. David N Juurlink, scientist and professor of medicine2
  1. 1Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
  2. 2Sunnybrook Health Sciences Centre, Toronto, ON, Canada, M4N 3M5
  1. david.juurlink{at}

We agree with Scheper and Lijfering that confounding by indication may arise when several antibiotics are considered in an observational study.1 2 Although most of the antibiotics we examined are used primarily for urinary tract infections in older patients, they are sometimes prescribed for other conditions, as we noted in our study. An exception is nitrofurantoin, which is used almost exclusively for uncomplicated urinary tract infections. We agree that this probably explains …

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