The presence of sulfamethoxazole and trimethoprim may also interfere with the Jaffé alkaline picrate reaction assay for creatinine, resulting in overestimations of about 10% in the range of normal values. For children, the recommended dose is 750 mg/m2/day sulfamethoxazole with 150 mg/m2/day trimethoprim given orally in equally divided doses twice a day, on 3 consecutive days per week. During administration of 800 mg sulfamethoxazole and 160 mg trimethoprim b.i.d., the mean steady-state plasma concentration of trimethoprim was 1.72 mcg/mL. It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination. Impairment of Fertility: No adverse effects on fertility or general reproductive performance were observed in rats given oral dosages as high as 350 mg/kg/day sulfamethoxazole plus 70 mg/kg/day trimethoprim doses roughly two times the recommended human daily dose on a body surface area basis. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Blood and urine tests may be needed to check for unwanted effects. The most common adverse effects are gastrointestinal disturbances (nausea, vomiting, anorexia) and allergic skin reactions (such as rash and urticaria). When administering these drugs concurrently, one should be alert for possible excessive phenytoin effect. There have been reports of marked but reversible nephrotoxicity with co-administration of sulfamethoxazole and trimethoprim and cyclosporine in renal transplant recipients. Caution should be exercised when sulfamethoxazole and trimethoprim is administered to a nursing woman, especially when breastfeeding, jaundiced, ill, stressed, or premature infants because of the potential risk of bilirubin displacement and kernicterus. Patients who are “slow acetylators” may be more prone to idiosyncratic reactions to sulfonamides. Precautions. It has been reported that sulfamethoxazole and trimethoprim may prolong the prothrombin time in patients who are receiving the anticoagulant warfarin (a CYP2C9 substrate). To date, there are limited data on the safety of repeated use of sulfamethoxazole and trimethoprim tablets in pediatric patients under two years of age. An identical daily dosage is used for 5 days in the treatment of shigellosis. If a significant blood dyscrasia or jaundice occurs, specific therapy should be instituted for these complications. [15], The combination of Trimethoprim with sulonamides and subsequent licensing was a purely business decision without any clinical need.[32]. When renal function is impaired, a reduced dosage should be employed using the following table: Acute Exacerbations of Chronic Bronchitis in Adults. Alternatively, other epidemiologic studies did not detect statistically significant associations between sulfamethoxazole/trimethoprim exposure and specific malformations. If signs of bone marrow depression occur, the patient should be given leucovorin 5 to 15 mg daily until normal hematopoiesis is restored. The usual adult dosage in the treatment of acute exacerbations of chronic bronchitis is 1 Sulfamethoxazole and Trimethoprim Double Strength tablet, or 2 sulfamethoxazole and trimethoprim single strength tablets, every 12 hours for 14 days. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Severe cases of thrombocytopenia that are fatal or life threatening have been reported. [3][7] In 2017, it was the 121st most commonly prescribed medication in the United States, with more than six million prescriptions. Clinical trials have confirmed its efficacy as a treatment for travellers' diarrhoea. Advertising revenue supports our not-for-profit mission. The following table is a guideline for the attainment of this dosage in children: For the treatment of traveler’s diarrhea, the usual adult dosage is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet or 2 sulfamethoxazole and trimethoprim single strength tablets every 12 hours for 5 days. [2][4] It appears to be safe for use during breastfeeding as long as the baby is healthy. Adjunctive treatment with Leucovorin for Pneumocystis jiroveci pneumonia. Severe and symptomatic hyponatremia can occur in patients receiving sulfamethoxazole and trimethoprim, particularly for the treatment of P. jiroveci pneumonia. As with all drugs containing sulfonamides, caution is advisable in patients with porphyria or thyroid dysfunction. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Sulfamethoxazole And Trimethoprim (Oral Route), FREE book offer – Mayo Clinic Health Letter. If you think you have become pregnant while using the medicine, tell your doctor right away. Serum digoxin levels should be monitored. Using these medicines together may cause these medicines to not work as well for you. The sulfonamides should not be used for treatment of group A β-hemolytic streptococcal infections. Acute Exacerbations of Chronic Bronchitis in Adults. Trimethoprim has been noted to impair phenylalanine metabolism but this is of no significance in phenylketonuric patients on appropriate dietary restriction. Indications & Usage INDICATIONS AND USAGE. SULFAMETHOXAZOLE; TRIMETHOPRIM or SMX-TMP (suhl fuh meth OK suh zohl; trye METH oh prim) is a combination of a sulfonamide antibiotic and a second antibiotic, trimethoprim. In an established infection, they will not eradicate the streptococcus and, therefore, will not prevent sequelae such as rheumatic fever. [21], Contraindications include the following:[14][22], Its use is advised against in patients being concomitantly treated with:[14][20][22][23][24][25], The recommended treatment for overdose includes:[20], Alkalinisation of the urine may reduce the toxicity of sulfamethoxazole, but it may increase the toxic effects of trimethoprim. Because of this, you may bleed or get infections more easily. In the literature, a single case of toxic delirium has been reported after concomitant intake of sulfamethoxazole/trimethoprim and amantadine (an OCT2 substrate). The incidence of congenital abnormalities was 4.5% (3 of 66) in those who received placebo and 3.3% (4 of 120) in those receiving sulfamethoxazole and trimethoprim. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile and surgical evaluation should be instituted as clinically indicated. This content does not have an English version. Check with your doctor right away if you have dark urine, clay-colored stools, stomach pain, or yellow eyes or skin. Respiratory: Cough, shortness of breath and pulmonary infiltrates (see WARNINGS). Cases of interactions with other OCT2 substrates, memantine and metformin, have also been reported. 4.2. In the literature, three cases of hyperkalemia in elderly patients have been reported after concomitant intake of sulfamethoxazole/trimethoprim and an angiotensin converting enzyme inhibitor6,7. The steady-state mean plasma levels of free and total sulfamethoxazole were 57.4 mcg/mL and 68 mcg/mL, respectively. Roche was concerned about the potential threat posed by the Wellcome rival, and to avoid a dispute or the threat of only one of the two drugs being allowed on the US market due to slightly better toxicology, the two manufactureres agreed to a shotgun marriage by mixing five parts of the bigger company's drug with one part of the smaller - reflecting each company's market share as of 1957! Connecticut Medicine [serial online]. Check with your doctor if you have anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness. Bridgewater, NJ 08807, Sulfamethoxazole and Trimethoprim Tablets, USP, Other brands: Bactrim, Co-trimoxazole, Septra, Sulfatrim, Keflex, Macrobid, Flagyl, prednisone, Bactrim DS, amoxicillin, doxycycline, cefpodoxime, azithromycin, triamcinolone, View Sulfamethoxazole / trimethoprim reviews. Hematologic: Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia. Thus, sulfamethoxazole and trimethoprim blocks two consecutive steps in the biosynthesis of nucleic acids and proteins essential to many bacteria. Ann Pharmacother. Espèces cibles Veaux, agneaux, porcins, lapins et volailles. An identical daily dosage is used for 5 days in the treatment of shigellosis. [20], The synergy between trimethoprim and sulfamethoxazole was first described in the late 1960s. Pneumocystis jiroveci Pneumonia: For the treatment of documented Pneumocystis jiroveci pneumonia and for prophylaxis against P. jiroveci pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing P. jiroveci pneumonia. In in vitro Comet, micronucleus and chromosomal damage assays using cultured human lymphocytes, trimethoprim was positive. Increased digoxin blood levels can occur with concomitant sulfamethoxazole and trimethoprim therapy, especially in elderly patients. Clostridium difficile associated diarrhea. In two studies in rats, no teratology was observed when 512 mg/kg of sulfamethoxazole was used in combination with 128 mg/kg of trimethoprim. Sulfamethoxazole and trimethoprim is contraindicated in pediatric patients less than 2 months of age. It has the following structural formula: Inactive Ingredients: Magnesium stearate, povidone, pregelatinized starch and sodium starch glycolate. In rare instances, a skin rash may be followed by a more severe reaction, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic necrosis and serious blood disorders (see PRECAUTIONS). Can I drink alcohol while taking sulfamethoxazole / trimethoprim DS tablets? These effects are reversible by folinic acid therapy. Even treatment with recommended doses may cause hyperkalemia when trimethoprim is administered to patients with underlying disorders of potassium metabolism, with renal insufficiency, or if drugs known to induce hyperkalemia are given concomitantly. Diuresis and hypoglycemia have occurred rarely in patients receiving sulfonamides. Last updated on Nov 1, 2019. Endocrine: The sulfonamides bear certain chemical similarities to some goitrogens, diuretics (acetazolamide and the thiazides) and oral hypoglycemic agents. This medicine, especially if you are receiving high doses or for a long period of time, may lower the number of platelets in your body, which are necessary for proper blood clotting. Acidification of the urine will increase renal elimination of trimethoprim. Sulfonamides can also displace methotrexate from plasma protein binding sites and can compete with the renal transport of methotrexate, thus increasing free methotrexate concentrations. [15], Sulfamethoxazole, a sulfonamide, induces its therapeutic effects by interfering with the de novo (that is, from within the cell) synthesis of folate inside microbial organisms such as protozoa, fungi and bacteria. These effects are reversible by folinic acid therapy. However, patients with severely impaired renal function exhibit an increase in the half-lives of both components, requiring dosage regimen adjustment (see DOSAGE AND ADMINISTRATION section). Using this medicine while you are pregnant can harm your unborn baby. [3] It is used for urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) skin infections, travelers' diarrhea, respiratory tract infections, and cholera, among others. When sulfamethoxazole and trimethoprim tablets are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed.
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