Trimethoprim-sulfamethoxazole: Difference between revisions
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+ | == Background == |
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− | = Trimethoprime-sulfamethoxazole (TMP-SMX) = |
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− | |||
− | == Identification == |
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− | |||
* Sulfonamide antibiotic |
* Sulfonamide antibiotic |
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− | == Brand Names == |
+ | === Brand Names === |
* Septra |
* Septra |
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== Dosing == |
== Dosing == |
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− | + | * Traditionally based on the trimethroprim component |
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+ | {| class="wikitable" |
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− | {| |
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! Form |
! Form |
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! TMP |
! TMP |
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! SMX |
! SMX |
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+ | !Conversion |
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|- |
|- |
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+ | | Intravenous |
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− | | Suspension |
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− | | 8 mg/ml |
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− | | 40 mg/ml |
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− | |- |
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− | | Injection |
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| 16 mg/ml |
| 16 mg/ml |
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| 80 mg/ml |
| 80 mg/ml |
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+ | |10 mL |
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+ | |- |
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+ | | Oral suspension |
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+ | | 8 mg/ml |
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+ | | 40 mg/ml |
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+ | |20 mL |
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|- |
|- |
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− | | SS tab |
+ | | Oral SS tab |
| 80 mg |
| 80 mg |
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| 400 mg |
| 400 mg |
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+ | |2 tabs |
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|- |
|- |
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− | | DS tab |
+ | | Oral DS tab |
| 160 mg |
| 160 mg |
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| 800 mg |
| 800 mg |
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+ | |1 tab |
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|} |
|} |
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+ | * Resistant Gram-negative infections |
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− | Conversion: 2 SS tabs = 1 DS tab = 20 mL oral suspension = 10 mL IV |
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+ | ** [[Cystitis]] or [[pyelonephritis]]: 160 mg/800 mg (1 DS tab) IV/PO q12h |
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+ | ** Other infections: 8 to 12 mg/kg/day IV/PO divided q8-12h (max 960 mg total daily dose) |
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+ | *[[Nocardia]]: 10 mg/kg TDD |
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+ | *[[Pneumocystis jirovecii]]: 15-20 mg/kg TDD |
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+ | *CNS infections: 15-20 mg/kg TDD |
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=== Oral Dosing === |
=== Oral Dosing === |
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* 10 to 20 mg/kg TMP total daily dose, split TID to QID |
* 10 to 20 mg/kg TMP total daily dose, split TID to QID |
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+ | {| class="wikitable" |
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− | ==== TMP 10 mg/kg per day ==== |
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+ | !Dose (TMP) |
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− | |||
− | {| |
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! Weight (kg) |
! Weight (kg) |
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+ | ! Total dose TMP (mg/day) |
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! Dose (IV) |
! Dose (IV) |
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+ | !Dose (PO) |
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− | ! Total dose TMP (mg/day) |
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|- |
|- |
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+ | | rowspan="5" |10 mg/kg |
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| 40-49 |
| 40-49 |
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− | | 10 mL q8h |
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| 480 |
| 480 |
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+ | | 10 mL q8h |
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+ | |1 DS tab q8h |
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|- |
|- |
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| 50-64 |
| 50-64 |
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− | | 10 mL q6h |
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| 640 |
| 640 |
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+ | | 10 mL q6h |
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+ | |1 DS tab q6h, or 2 DS tabs q12h |
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|- |
|- |
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| 65-74 |
| 65-74 |
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− | | 15 mL q8h |
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| 720 |
| 720 |
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+ | | 15 mL q8h |
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+ | |3 SS tabs q8h |
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|- |
|- |
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| 75-99 |
| 75-99 |
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+ | | 960 |
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| 15 mL q6h |
| 15 mL q6h |
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+ | |2 DS tabs q8h, or 3 SS tabs q6h |
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− | | 960 |
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|- |
|- |
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| 100-129 |
| 100-129 |
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+ | | 1280 |
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| 20 mL q6h |
| 20 mL q6h |
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+ | |2 DS tabs q6h |
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− | | 1280 |
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− | |} |
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− | |||
− | ==== TMP 15 mg/kg per day ==== |
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− | |||
− | {| |
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− | ! Weight (kg) |
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− | ! Dose (IV) |
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− | ! Total dose TMP (mg/day) |
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|- |
|- |
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+ | | rowspan="9" |15 mg/kg |
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− | | 40-44 |
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+ | |40-44 |
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− | | 10 mL q6h |
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− | | |
+ | |640 |
+ | |10 mL q6h |
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+ | |1 DS tab q6h, or 2 DS tabs q12h |
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|- |
|- |
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− | | |
+ | |45-49 |
+ | |720 |
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− | | 15 mL q8h |
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+ | |15 mL q8h |
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− | | 720 |
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+ | |3 SS tabs q8h |
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|- |
|- |
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− | | |
+ | |50-69 |
+ | |960 |
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− | | 15 mL q6h |
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+ | |15 mL q6h |
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− | | 960 |
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+ | |2 DS tabs q8h, or 3 SS tabs q6h |
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|- |
|- |
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− | | |
+ | |70-79 |
+ | |1200 |
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− | | 25 mL q8h |
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+ | |25 mL q8h |
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− | | 1200 |
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+ | |5 SS tabs q8h |
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|- |
|- |
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− | | |
+ | |80-89 |
+ | |1280 |
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− | | 20 mL q6h |
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+ | |20 mL q6h |
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− | | 1280 |
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+ | |2 DS tabs q6h |
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|- |
|- |
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− | | |
+ | |90-99 |
+ | |1440 |
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− | | 30 mL q8h |
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+ | |30 mL q8h |
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− | | 1440 |
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+ | |3 DS tabs q8h |
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|- |
|- |
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− | | |
+ | |100-109 |
+ | |1600 |
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− | | 25 mL q6h |
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+ | |25 mL q6h |
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− | | 1600 |
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+ | |2/2/3/3 DS tabs q6h, or 5 SS tabs q6h |
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|- |
|- |
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− | | |
+ | |110-119 |
+ | |1680 |
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− | | 35 mL q8h |
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+ | |35 mL q8h |
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− | | 1680 |
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+ | |7 SS tabs q8h |
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|- |
|- |
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− | | |
+ | |120-129 |
+ | |1920 |
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− | | 30 mL q6h |
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+ | |30 mL q6h |
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− | | 1920 |
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+ | |3 DS tabs q6h |
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− | |} |
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− | |||
− | ==== TMP 20 mg/kg per day ==== |
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− | |||
− | {| |
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− | ! Weight (kg) |
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− | ! Dose (IV) |
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− | ! Total dose TMP (mg/day) |
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|- |
|- |
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+ | | rowspan="7" |20 mg/kg |
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− | | 40-54 |
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+ | |40-54 |
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− | | 15 mL q6h |
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− | | |
+ | |960 |
+ | |15 mL q6h |
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+ | |2 DS tabs q8h, or 3 SS tabs q6h |
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|- |
|- |
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− | | |
+ | |55-69 |
+ | |1280 |
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− | | 20 mL q6h |
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+ | |20 mL q6h |
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− | | 1280 |
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+ | |2 DS tabs q6h |
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|- |
|- |
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− | | |
+ | |70-79 |
+ | |1440 |
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− | | 30 mL q8h |
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+ | |30 mL q8h |
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− | | 1440 |
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+ | |3 DS tabs q8h |
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|- |
|- |
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− | | |
+ | |80-89 |
+ | |1600 |
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− | | 25 mL q6h |
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+ | |25 mL q6h |
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− | | 1600 |
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+ | |2/2/3/3 DS tabs q6h, or 5 SS tabs q6h |
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|- |
|- |
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− | | |
+ | |90-104 |
+ | |1920 |
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− | | 30 mL q6h |
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+ | |30 mL q6h |
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− | | 1920 |
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+ | |3 DS tabs q6h |
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|- |
|- |
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− | | |
+ | |105-119 |
+ | |2240 |
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− | | 35 mL q6h |
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+ | |35 mL q6h |
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− | | 2240 |
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+ | |3/3/4/4 DS tabs q6h, or 7 SS tabs q6h |
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|- |
|- |
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− | | |
+ | |120-134 |
+ | |2560 |
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− | | 40 mL q6h |
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+ | |40 mL q6h |
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− | | 2560 |
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+ | |4 DS tabs q6h |
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|} |
|} |
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==== Renal Dosing ==== |
==== Renal Dosing ==== |
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+ | {| class="wikitable" |
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− | {| |
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! CrCl (mL/min) |
! CrCl (mL/min) |
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! Bacterial infection (TMP) |
! Bacterial infection (TMP) |
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|} |
|} |
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− | == |
+ | == Adverse Drug Reactions == |
+ | * Systemic allergic reactions |
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− | |||
+ | **[[Adverse drug reaction::Anaphylaxis]] |
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− | * Allergic reactions, including anaphylaxis and a relatively high rate of SJS/TEN |
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+ | **[[Adverse drug reaction::Serum sickness]] |
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− | * GI upset, including nausea at higher doses |
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+ | *Cutaneous reactions |
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− | * Interactions |
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+ | **High rate of [[Adverse drug reaction::SJS]]/[[Adverse drug reaction::TEN]] |
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− | ** Increases warfarin levels |
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+ | **Other non-specific rash |
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− | * Anemia, neutropenia and thrombocytopenia |
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+ | **[[Adverse drug reaction::Erythema multiforme]] |
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+ | **[[Adverse drug reaction::Urticaria]] |
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+ | **[[Adverse drug reaction::Photodermatitis]] |
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+ | * [[Adverse drug reaction::GI upset]], including nausea at higher doses |
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+ | * [[Adverse drug reaction::Drug-drug interactions]] |
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+ | ** Increases [[warfarin]] levels |
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+ | * [[Adverse drug reaction::Anemia]], [[Adverse drug reaction::neutropenia]] and [[Adverse drug reaction::thrombocytopenia]] |
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** It is a mild folate antagonist |
** It is a mild folate antagonist |
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− | * Hepatotoxicity |
+ | * [[Adverse drug reaction::Hepatotoxicity]] |
− | * Hyperkalemia |
+ | * [[Adverse drug reaction::Hyperkalemia]] |
+ | *[[Adverse drug reaction::Hyponatremia]] |
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− | * Hypoglycemia |
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+ | * [[Adverse drug reaction::Hypoglycemia]] |
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− | * Acute kidney injury, though it also increases tubular creatinine reabsorption |
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+ | * [[Adverse drug reaction::Acute kidney injury]], though it also increases tubular creatinine reabsorption |
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− | * Renal tubular acidosis |
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+ | * [[Adverse drug reaction::Renal tubular acidosis]] |
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== Further Reading == |
== Further Reading == |
||
− | * |
+ | * Considerations when prescribing trimethoprim-sulfamethoxazole. ''CMAJ''. 2011;183(16):1851-1858. doi: [https://doi.org/10.1503/cmaj.111152 10.1503/cmaj.111152] |
+ | ** Review of adverse events |
||
+ | |||
+ | [[Category:Antibiotics]] |
Latest revision as of 14:04, 20 August 2024
Background
- Sulfonamide antibiotic
Brand Names
- Septra
- Bactrim (US)
- TMP-SMX
Dosing
- Traditionally based on the trimethroprim component
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
Oral Dosing
- Ranges from 1 SS tab BID (160 mg TMP TDD) to 3 DS tabs TID (1440 mg TMP TDD)
Intravenous Dosing
- 10 to 20 mg/kg TMP total daily dose, split TID to QID
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 |
Renal Dosing
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 |
Adverse Drug Reactions
- Systemic allergic reactions
- Cutaneous reactions
- High rate of SJS/TEN
- Other non-specific rash
- Erythema multiforme
- Urticaria
- Photodermatitis
- GI upset, including nausea at higher doses
- Drug-drug interactions
- Increases warfarin levels
- Anemia, neutropenia and thrombocytopenia
- It is a mild folate antagonist
- Hepatotoxicity
- Hyperkalemia
- Hyponatremia
- Hypoglycemia
- Acute kidney injury, though it also increases tubular creatinine reabsorption
- Renal tubular acidosis
Further Reading
- Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ. 2011;183(16):1851-1858. doi: 10.1503/cmaj.111152
- Review of adverse events