Trimethoprim-Sulfamethoxazole DS: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: [[Sulfonamide]] | ||
*Dosage Forms: | *Dosage Forms: 160/800; 40mg TMP/5mL | ||
*Common Trade Names: | *Common Trade Names: Bactrim DS | ||
*Abbreviations: TMP-SMX, TMP-SMZ | |||
==Adult Dosing== | ==Adult Dosing== | ||
===General=== | |||
1 tab (160mg TMP) PO Q12h | |||
===[[PCP]] Prophylaxis=== | |||
80-160mg TMP PO daily | |||
===[[PCP]] Treatment=== | |||
15-20mg/kg/day TMP PO divided q6-8h x 21 days | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===General (>2mo)=== | |||
*Mild-mod infection | |||
**4-5mg/kg TMP PO q12hr | |||
*Severe infection | |||
**15-20mg/kg/dy TMP PO divided q6-8h | |||
==Special Populations== | |||
*Pregnancy: D | |||
*Lactation: ? | |||
*Renal (Adult & Pediatric) | |||
**CrCl 15-30: Decrease dose by 50% | |||
**CrCl <15: Avoid use | |||
**Hemodialysis: Give supplement | |||
**Peritoneal Dialysis: No supplement | |||
*Hepatic (Adult & Pediatric)<ref>Trimethoprim-sulfamethoxazole (co-trimoxazole): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019. </ref> | |||
**Mild-mod impairment: Caution advised | |||
**Significant impairment: Contraindicated | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*<2 months of age (except as PCP prophylaxis) | |||
*Significant hepatic impairment | |||
*Megaloblastic anemia or folate deficiency | |||
*G6PD deficiency | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | |||
*[[Stevens-Johnson Syndrome]] | |||
*[[Toxic Epidermal Necrolysis]] | |||
*Fulminant hepatic necrosis | |||
*Agranulocytosis | |||
*Aplastic anemia | |||
*Blood dyscrasias | |||
*[[Thrombocytopenia]] | |||
*[[Hypersensitivity Reaction]] | |||
*Photosensitivity | |||
*Hepatotoxicity | |||
*[[Pancreatitis]] | |||
*Intersitial nephritis | |||
*[[Renal Failure]] | |||
*Pulmonary infiltrates | |||
*Myelosuppression | |||
*Methhemoglobinemia | |||
*[[Hyperkalemia]] | |||
*[[Hyponatremia]] | |||
*Aseptic [[meningitis]] | |||
*[[Seizures]] | |||
*Lupus Erythematosus | |||
*[[Hypoglycemia]] | |||
*[[Clostridium difficile]] | |||
*[[Rhabdomyolysis]] | |||
*Congenital malformations | |||
*Congenital neural tube defects | |||
*[[Kernicterus]] (neonates) | |||
==Common== | |||
*[[Nausea and Vomiting]] | |||
*Anorexia | |||
*[[Rash]] | |||
*Urticaria | |||
*[[Hypersensitivity Reaction]] | |||
*Photosensitivity | |||
*[[Diarrhea]] | |||
*[[Dizziness]] | |||
*[[Dyspepsia]] | |||
*[[Headache]] | |||
*Lethargy | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 6-12h (20-50h ESRD) | ||
*Metabolism: | *Metabolism: | ||
** Hepatic | |||
*Excretion: | *Excretion: | ||
*Mechanism of Action: | ** Urine - both as unchanged drug and metabolites | ||
*Mechanism of Action: Bactericidal via interfering with folic acid synthesis | |||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||X22 | |||
|- | |||
| ||[[Strep. Pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Viridans strep]]||X1 | |||
|- | |||
| ||Strep. anginosus gp||X1 | |||
|- | |||
| ||[[Enterococcus faecalis]]||X22 | |||
|- | |||
| ||[[Enterococcus faecium]]||R | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||'''S''' | |||
|- | |||
| ||[[CA-MRSA]]||'''S''' | |||
|- | |||
| ||[[Staph. Epidermidis]]||I | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||'''S''' | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||I | |||
|- | |||
| ||[[N. meningitidis]]||X2 | |||
|- | |||
| ||[[Moraxella catarrhalis]]||'''S''' | |||
|- | |||
| ||[[H. influenzae]]||I | |||
|- | |||
| ||[[E. coli]]||I | |||
|- | |||
| ||[[Klebsiella]] sp||I | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||I | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||X1 | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||X1 | |||
|- | |||
| ||[[Serratia]] sp||X1 | |||
|- | |||
| ||Serratia marcescens||I | |||
|- | |||
| ||[[Salmonella]] sp||I | |||
|- | |||
| ||[[Shigella]] sp||I | |||
|- | |||
| ||[[Proteus mirabilis]]||S<ref>GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.</ref> | |||
|- | |||
| ||[[Proteus vulgaris]]||S<ref>GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.</ref> | |||
|- | |||
| ||[[Providencia sp.]]||X1 | |||
|- | |||
| ||[[Morganella sp.]]||X1 | |||
|- | |||
| ||[[Citrobacter freundii]]||X1 | |||
|- | |||
| ||[[Citrobacter diversus]]||X1 | |||
|- | |||
| ||[[Citrobacter sp.]]||X1 | |||
|- | |||
| ||[[Aeromonas sp]]||X1 | |||
|- | |||
| ||[[Acinetobacter sp.]]||I | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||R | |||
|- | |||
| ||[[Burkholderia cepacia]]||'''S''' | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||'''S''' | |||
|- | |||
| ||[[Yersinia enterocolitica]]||'''S''' | |||
|- | |||
| ||[[Francisella tularensis]]||'''S''' | |||
|- | |||
| ||[[Brucella sp.]]||X2 | |||
|- | |||
| ||[[Legionella sp.]]||'''S''' | |||
|- | |||
| ||[[Pasteurella multocida]]||X1 | |||
|- | |||
| ||[[Haemophilus ducreyi]]||I | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||X1 | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||X1 | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||X1 | |||
|- | |||
| ||[[Bacteroides fragilis]]||R | |||
|- | |||
| ||[[Prevotella melaninogenica]]||X1 | |||
|- | |||
| ||[[Clostridium difficile]]||X1 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||X1 | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||X1 | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||X1 | |||
|} | |||
== | ===Key=== | ||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | |||
[[Category:ID]] | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Pharmacology]] |
Revision as of 23:11, 23 September 2019
General
- Type: Sulfonamide
- Dosage Forms: 160/800; 40mg TMP/5mL
- Common Trade Names: Bactrim DS
- Abbreviations: TMP-SMX, TMP-SMZ
Adult Dosing
General
1 tab (160mg TMP) PO Q12h
PCP Prophylaxis
80-160mg TMP PO daily
PCP Treatment
15-20mg/kg/day TMP PO divided q6-8h x 21 days
Pediatric Dosing
General (>2mo)
- Mild-mod infection
- 4-5mg/kg TMP PO q12hr
- Severe infection
- 15-20mg/kg/dy TMP PO divided q6-8h
Special Populations
- Pregnancy: D
- Lactation: ?
- Renal (Adult & Pediatric)
- CrCl 15-30: Decrease dose by 50%
- CrCl <15: Avoid use
- Hemodialysis: Give supplement
- Peritoneal Dialysis: No supplement
- Hepatic (Adult & Pediatric)[1]
- Mild-mod impairment: Caution advised
- Significant impairment: Contraindicated
Contraindications
- Allergy to class/drug
- <2 months of age (except as PCP prophylaxis)
- Significant hepatic impairment
- Megaloblastic anemia or folate deficiency
- G6PD deficiency
Adverse Reactions
Serious
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
- Fulminant hepatic necrosis
- Agranulocytosis
- Aplastic anemia
- Blood dyscrasias
- Thrombocytopenia
- Hypersensitivity Reaction
- Photosensitivity
- Hepatotoxicity
- Pancreatitis
- Intersitial nephritis
- Renal Failure
- Pulmonary infiltrates
- Myelosuppression
- Methhemoglobinemia
- Hyperkalemia
- Hyponatremia
- Aseptic meningitis
- Seizures
- Lupus Erythematosus
- Hypoglycemia
- Clostridium difficile
- Rhabdomyolysis
- Congenital malformations
- Congenital neural tube defects
- Kernicterus (neonates)
Common
- Nausea and Vomiting
- Anorexia
- Rash
- Urticaria
- Hypersensitivity Reaction
- Photosensitivity
- Diarrhea
- Dizziness
- Dyspepsia
- Headache
- Lethargy
Pharmacology
- Half-life: 6-12h (20-50h ESRD)
- Metabolism:
- Hepatic
- Excretion:
- Urine - both as unchanged drug and metabolites
- Mechanism of Action: Bactericidal via interfering with folic acid synthesis
Antibiotic Sensitivities[2]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Trimethoprim-sulfamethoxazole (co-trimoxazole): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.
- ↑ Sanford Guide to Antimicrobial Therapy 2014
- ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.
- ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.