Trimethoprim-sulfamethoxazole: Difference between revisions
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= Identification = |
== Identification == |
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* Sulfonamide antibiotic |
* Sulfonamide antibiotic |
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= Brand Names = |
== Brand Names == |
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* Septra |
* Septra |
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* TMP-SMX |
* TMP-SMX |
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= Dosing = |
== Dosing == |
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Based on the trimethroprim component. |
Based on the trimethroprim component. |
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Conversion: 2 SS tabs = 1 DS tab = 20 mL oral suspension = 10 mL IV |
Conversion: 2 SS tabs = 1 DS tab = 20 mL oral suspension = 10 mL IV |
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== Oral Dosing == |
=== Oral Dosing === |
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* Ranges from 1 SS tab BID (160 mg TMP TDD) to 3 DS tabs TID (1440 mg TMP TDD) |
* Ranges from 1 SS tab BID (160 mg TMP TDD) to 3 DS tabs TID (1440 mg TMP TDD) |
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== Intravenous Dosing == |
=== Intravenous 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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== TMP 10 mg/kg per day == |
=== TMP 10 mg/kg per day === |
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== TMP 15 mg/kg per day == |
=== TMP 15 mg/kg per day === |
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== TMP 20 mg/kg per day == |
=== TMP 20 mg/kg per day === |
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== Renal Dosing == |
=== Renal Dosing === |
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= Notable Side Effects = |
== Notable Side Effects == |
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* Allergic reactions, including anaphylaxis and a relatively high rate of SJS/TEN |
* Allergic reactions, including anaphylaxis and a relatively high rate of SJS/TEN |
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* Renal tubular acidosis |
* Renal tubular acidosis |
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= Further Reading = |
== Further Reading == |
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* Review of adverse effects: [https://doi.org/10.1503/cmaj.111152 Considerations when prescribing trimethoprim-sulfamethoxazole]. ''CMAJ''. 2011(16):1851-1858 |
* Review of adverse effects: [https://doi.org/10.1503/cmaj.111152 Considerations when prescribing trimethoprim-sulfamethoxazole]. ''CMAJ''. 2011(16):1851-1858 |
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Revision as of 15:29, 17 August 2019
Identification
- Sulfonamide antibiotic
Brand Names
- Septra
- Bactrim (US)
- TMP-SMX
Dosing
Based on the trimethroprim component.
| Form | TMP | SMX |
|---|---|---|
| Suspension | 8 mg/ml | 40 mg/ml |
| Injection | 16 mg/ml | 80 mg/ml |
| SS tab | 80 mg | 400 mg |
| DS tab | 160 mg | 800 mg |
Conversion: 2 SS tabs = 1 DS tab = 20 mL oral suspension = 10 mL IV
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
TMP 10 mg/kg per day
| Weight (kg) | Dose (IV) | Total dose TMP (mg/day) |
|---|---|---|
| 40-49 | 10 mL q8h | 480 |
| 50-64 | 10 mL q6h | 640 |
| 65-74 | 15 mL q8h | 720 |
| 75-99 | 15 mL q6h | 960 |
| 100-129 | 20 mL q6h | 1280 |
TMP 15 mg/kg per day
| Weight (kg) | Dose (IV) | Total dose TMP (mg/day) |
|---|---|---|
| 40-44 | 10 mL q6h | 640 |
| 45-49 | 15 mL q8h | 720 |
| 50-69 | 15 mL q6h | 960 |
| 70-79 | 25 mL q8h | 1200 |
| 80-89 | 20 mL q6h | 1280 |
| 90-99 | 30 mL q8h | 1440 |
| 100-109 | 25 mL q6h | 1600 |
| 110-119 | 35 mL q8h | 1680 |
| 120-129 | 30 mL q6h | 1920 |
TMP 20 mg/kg per day
| Weight (kg) | Dose (IV) | Total dose TMP (mg/day) |
|---|---|---|
| 40-54 | 15 mL q6h | 960 |
| 55-69 | 20 mL q6h | 1280 |
| 70-79 | 30 mL q8h | 1440 |
| 80-89 | 25 mL q6h | 1600 |
| 90-104 | 30 mL q6h | 1920 |
| 105-119 | 35 mL q6h | 2240 |
| 120-134 | 40 mL q6h | 2560 |
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 |
Notable Side Effects
- Allergic reactions, including anaphylaxis and a relatively high rate of SJS/TEN
- GI upset, including nausea at higher doses
- Interactions
- Increases warfarin levels
- Anemia, neutropenia and thrombocytopenia
- It is a mild folate antagonist
- Hepatotoxicity
- Hyperkalemia
- Hypoglycemia
- Acute kidney injury, though it also increases tubular creatinine reabsorption
- Renal tubular acidosis
Further Reading
- Review of adverse effects: Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ. 2011(16):1851-1858
