Trimethoprim-sulfamethoxazole: Difference between revisions
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* [[Adverse drug reaction::GI upset]], including nausea at higher doses |
* [[Adverse drug reaction::GI upset]], including nausea at higher doses |
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* [[Adverse drug reaction::Drug-drug interactions]] |
* [[Adverse drug reaction::Drug-drug interactions]] |
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** Increases warfarin levels |
** Increases [[warfarin]] levels |
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* [[Adverse drug reaction::Anemia]], [[Adverse drug reaction::neutropenia]] and [[Adverse drug reaction::thrombocytopenia]] |
* [[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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Revision as of 13:38, 30 March 2022
Background
- Sulfonamide antibiotic
Brand Names
- Septra
- Bactrim (US)
- TMP-SMX
Dosing
- Traditionally 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
- Resistant Gram-negative infections
- Cystitis: 160 mg (1 SS tab) IV/PO q12h
- Other infections: 8 to 12 mg/kg/day IV/PO divided q8-12h (max 960 mg total daily dose)
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 |
Adverse Drug Reactions
- Allergic reactions, including anaphylaxis and a relatively high rate of SJS/TEN
- 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
- 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
