Ver el código de «Trimethoprim-Sulfamethoxazole DS»

==General==
*Type: [[Is DrugClass::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: [[Drug pregnancy categories|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==
*Allergy to class/drug
*<2 months of age (except as PCP prophylaxis)
*Significant hepatic impairment
*Megaloblastic anemia or folate deficiency
*G6PD deficiency
*Pregnancy (class D)

==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
*[[Methemoglobinemia]]
*[[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]]<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}}

==Comments==
'''Bactrim dosing is based on the trimethoprim part not the sulfamethoxazole part.'''
*The dosing in 8-10mg/kg of trimethoprim divided q12 hours (4-5 mg/kg per dose). 
*The concentration of Bactrim is 200 mg of sulfamethoxazole and 40 mg of trimethoprim in 5 mL.
*Example: 10 kg child - 8mg/kg per day of trimethoprim part which is 80 mg per day. Divide by 2 = 40 mg of trimethoprim per dose. Based on the above concentration patient will get 5 mL of Bactrim 2 times per day.

==See Also==
*[[Antibiotics (Main)]]
[[Category:ID]]

==References==
<references/>

[[Category:Pharmacology]]