Trimethoprim-sulfamethoxazole

Background

Form	TMP	SMX	Conversion
Intravenous	16 mg/ml	80 mg/ml	10 mL
Oral suspension	8 mg/ml	40 mg/ml	20 mL
Oral SS tab	80 mg	400 mg	2 tabs
Oral DS tab	160 mg	800 mg	1 tab

Resistant Gram-negative infections
- Cystitis or pyelonephritis: 160 mg/800 mg (1 DS tab) IV/PO q12h
- Other infections: 8 to 12 mg/kg/day IV/PO divided q8-12h (max 960 mg total daily dose)
Nocardia: 10 mg/kg TDD
Pneumocystis jirovecii: 15-20 mg/kg TDD
CNS infections: 15-20 mg/kg TDD

Dose (TMP)	Weight (kg)	Total dose TMP (mg/day)	Dose (IV)	Dose (PO)
10 mg/kg	40-49	480	10 mL q8h	1 DS tab q8h
	50-64	640	10 mL q6h	1 DS tab q6h, or 2 DS tabs q12h
	65-74	720	15 mL q8h	3 SS tabs q8h
	75-99	960	15 mL q6h	2 DS tabs q8h, or 3 SS tabs q6h
	100-129	1280	20 mL q6h	2 DS tabs q6h
15 mg/kg	40-44	640	10 mL q6h	1 DS tab q6h, or 2 DS tabs q12h
	45-49	720	15 mL q8h	3 SS tabs q8h
	50-69	960	15 mL q6h	2 DS tabs q8h, or 3 SS tabs q6h
	70-79	1200	25 mL q8h	5 SS tabs q8h
	80-89	1280	20 mL q6h	2 DS tabs q6h
	90-99	1440	30 mL q8h	3 DS tabs q8h
	100-109	1600	25 mL q6h	2/2/3/3 DS tabs q6h, or 5 SS tabs q6h
	110-119	1680	35 mL q8h	7 SS tabs q8h
	120-129	1920	30 mL q6h	3 DS tabs q6h
20 mg/kg	40-54	960	15 mL q6h	2 DS tabs q8h, or 3 SS tabs q6h
	55-69	1280	20 mL q6h	2 DS tabs q6h
	70-79	1440	30 mL q8h	3 DS tabs q8h
	80-89	1600	25 mL q6h	2/2/3/3 DS tabs q6h, or 5 SS tabs q6h
	90-104	1920	30 mL q6h	3 DS tabs q6h
	105-119	2240	35 mL q6h	3/3/4/4 DS tabs q6h, or 7 SS tabs q6h
	120-134	2560	40 mL q6h	4 DS tabs q6h

CrCl (mL/min)	Bacterial infection (TMP)	PJP (TMP)
> 30	8-12 mg/kg/day in 2-4 divided doses	15-20 mg/kg/day in 2-4 divided doses
10 to 29	75% of usual dose	12-15 mg/kg/day in 2-4 divided doses
< 10, including PD	Generally not recommended; use 50% of usual dose	Generally not recommended; use 7.5-10 mg/kg/day in 2-4 divided doses
Hemodialysis	50% of usual dose, scheduled post-dialysis	50% of usual dose, scheduled post-dialysis
CRRT	7.5 mg/kg/day in 2-4 divided doses	15 mg/kg/day in 2-4 divided doses