Diferencia entre revisiones de «Trimethoprim-Sulfamethoxazole DS»

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==General==
==General==
*Type:  
*Type: [[Is DrugClass::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
===Indications by Disease===
{{#ask: [[Has DrugName::Trimethoprim-Sulfamethoxazole DS]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==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
===Indications by Disease===
{{#ask: [[Has DrugName::Trimethoprim-Sulfamethoxazole DS]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
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==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==
==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
*Pregnancy (class D)


==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
*[[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==
==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}}


==Pregnancy/Lactation==
==Comments==
*Pregnancy:
'''Bactrim dosing is based on the trimethoprim part not the sulfamethoxazole part.'''
*Lactation:
*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==
==See Also==
*[[Antibiotics (Main)]]
[[Category:ID]]


==Source==
==References==
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]

Revisión actual - 11:07 20 mar 2026

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



Indications by Disease

DiseaseDoseContext
Acute cystitisDS (160/800mg) 1 tab BID x 3d (Females) x7days (Males)Outpatient, Women Uncomplicated
Acute diarrhea1 DS tab PO BID x 5 daysSalmonella
Acute diarrhea1 DS tab PO BID x 5 daysShigella
Acute diarrhea1 tablet (5mg/kg) PO BID daily x 3 dailyVibrio cholerae
Acute diarrhea1 DS tab (5mg/kg) PO BIDYersinia
Cellulitis2 DS tablets PO q12hrs x 10 daysFreshwater
CellulitisDS 1 tab PO BIDOutpatient, MRSA
Diabetic foot infection2DS tabs PO q12hrs daily x 14 daysModerate DFI
Diabetic foot infection2DS tabs PO q12hrs daily x 14 daysMild DFI
Diverticulitisone double-strength tablet BIDUncomplicated, PCN allergy
Felon2 DS tablets PO q12hrs x 7 daysOutpatient
Mammalian bites5mg/kg IV q12hrsSevere mammalian bite with Clindamycin
Mammalian bites2 DS tabs (5mg/kg) PO q12hrsCat and dog bites with Clindamycin
Mammalian bites2 DS tabs (5mg/kg) PO q12hrsHuman bites with Clindamycin
Periorbital cellulitis1-2 double-strength tablets BIDOutpatient
Pneumocystis jirovecii pneumonia2 DS tablets PO q8hrsMild disease
Pneumocystis jirovecii pneumonia5mg/kg IV q8hrs x 21 daysSevere disease
Pneumocystis jirovecii pneumonia1 DS tablet dailyProphylaxis
Prostatitis1 DS tablet PO q12hrs x 28 daysNon-STD/Chronic
Pyelonephritis160/800mg PO BID x14 daysOutpatient
Septic bursitis2 DS tabs PO two times daily x 14 daysOutpatient
Toxoplasmosis5mg/kg IV q12hrsImmunosuppressed alt

Pediatric Dosing

General (>2mo)

  • Mild-mod infection
    • 4-5mg/kg TMP PO q12hr
  • Severe infection
    • 15-20mg/kg/dy TMP PO divided q6-8h


Indications by Disease

DiseaseDoseContext
Acute cystitis6-12mg/kg/day (TMP) PO divided BID x 7-10 daysPediatric
Acute diarrhea8mg/kg/day (TMP) PO divided BID x 5 daysPediatric Salmonella
Acute diarrhea8mg/kg/day (TMP) PO divided BID x 5 daysPediatric Shigella
Cellulitis8-12mg/kg/day (TMP) PO divided BIDPediatric Outpatient, MRSA
Infectious tenosynovitis5mg/kg IV BIDPediatrics
Mammalian bites8-12mg/kg/day (TMP) PO divided BIDPediatric PCN allergy with Clindamycin
Mammalian bites8-12mg/kg/day (TMP) PO divided BIDPediatric Human bites with Clindamycin
Periorbital cellulitis8 to 12 mg/kg QD of the TMP component divided every 12 hoursOutpatient
Pertussis4mg/kg PO BID daily for 14 days>1 month old (if >2mo)
Pneumocystis jirovecii pneumonia5mg/kg (TMP) IV/PO q6-8hrs x 21 daysPediatric Treatment
Pneumocystis jirovecii pneumonia5mg/kg/day (TMP) PO divided BID 3 days/weekPediatric Prophylaxis
Pyelonephritis6-12mg/kg/day (TMP) PO divided BID x 10-14 daysPediatric Outpatient
Toxoplasmosis5mg/kg (TMP) PO/IV q12hrsPediatric Immunosuppressed alt

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
  • Pregnancy (class D)

Adverse Reactions

Serious

Common

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]

Group Organism 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[3]
Proteus vulgaris S[4]
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

  • 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

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

References

  1. ↑ Trimethoprim-sulfamethoxazole (co-trimoxazole): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.
  2. ↑ Sanford Guide to Antimicrobial Therapy 2014
  3. ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.
  4. ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.
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