CASE REPORT article
Front. Antibiot.
Sec. Pharmacology
Case Report: Severe Hypokalemia Induced by Ceftazidime-Avibactam
Provisionally accepted
- 1Department of Rehabilitation, Hebei General Hospital, Shijiazhuang, China
- 2Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
- 3Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Rationale Ceftazidime-avibactam is widely used to treat infections caused by carbapenem-resistant Gram-negative bacteria. It is generally safe, but severe hypokalemia related to its use has rarely been reported. Patient concerns A 74-year-old man with severe pneumonia and acute cerebral infarction was treated with ceftazidime-avibactam after sputum culture and nucleic acid testing revealed multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae. Shortly after starting therapy, he developed persistent and refractory hypokalemia. Diagnosis The diagnosis was severe hypokalemia induced by ceftazidime-avibactam. Interventions Antimicrobial therapy was continued, and the patient received oral spironolactone and nasogastric potassium chloride. Because hypokalemia persisted and acute kidney injury developed, the ceftazidime-avibactam dose was reduced by half. After the adjustment and continued potassium replacement, serum potassium levels gradually stabilized. Outcome The patient's condition worsened due to multiple organ failure and septic shock. At the family's request, he was discharged against medical advice. Lessons This case indicates that avibactam might increase potassium loss by enhancing tubular secretion and raising the negative charge in renal tubules. Clinicians should be aware of this potential adverse effect, especially in elderly patients or those with renal dysfunction. Regular monitoring of serum and urinary potassium and early correction of abnormalities are strongly recommended during ceftazidime-avibactam treatment.
Keywords: Adverse Drug Reaction, Carbapenem-resistant Gram-negative bacteria, case report, Ceftazidime-avibactam, Hypokalemia
Received: 31 Oct 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Yuan, Gu, Liu, Li and Yin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yu Yin
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