Trimethoprim-sulfamethoxazole: Difference between revisions

From IDWiki
m (→)
(added weight based oral dosing equivalents)
Line 16: Line 16:
! TMP
! TMP
! SMX
! SMX
!Conversion
|-
|-
| Intravenous
| Suspension
⚫
| 8 mg/ml
⚫
| 40 mg/ml
⚫
|-
| Injection
| 16 mg/ml
| 16 mg/ml
| 80 mg/ml
| 80 mg/ml
⚫
|10 mL
⚫
|-
| Oral suspension
⚫
| 8 mg/ml
⚫
| 40 mg/ml
⚫
|20 mL
|-
|-
| SS tab
| Oral SS tab
| 80 mg
| 80 mg
| 400 mg
| 400 mg
|2 tabs
|-
|-
| DS tab
| Oral DS tab
| 160 mg
| 160 mg
| 800 mg
| 800 mg
|1 tab
|}
|}


* Conversion: 2 SS tabs = 1 DS tab = 20 mL oral suspension = 10 mL IV
* Resistant Gram-negative infections
* Resistant Gram-negative infections
** [[Cystitis]]: 160 mg (1 SS tab) IV/PO q12h
** [[Cystitis]]: 160 mg (1 SS tab) IV/PO q12h
Line 51: Line 55:
{| class="wikitable"
{| class="wikitable"
! Weight (kg)
! Weight (kg)
⚫
! Dose (IV)
! Total dose TMP (mg/day)
! Total dose TMP (mg/day)
⚫
! Dose (IV)
⚫
!Dose (PO)
|-
|-
| 40-49
| 40-49
⚫
| 480
| 10 mL q8h
| 10 mL q8h
⚫
|1 DS tab q8h
⚫
| 480
|-
|-
| 50-64
| 50-64
⚫
| 640
| 10 mL q6h
| 10 mL q6h
|1 DS tab q6h, or 2 DS tabs q12h
⚫
| 640
|-
|-
| 65-74
| 65-74
⚫
| 720
| 15 mL q8h
| 15 mL q8h
⚫
|3 SS tabs q8h
⚫
| 720
|-
|-
| 75-99
| 75-99
⚫
| 960
| 15 mL q6h
| 15 mL q6h
|2 DS tabs q8h, or 3 SS tabs q6h
⚫
| 960
|-
|-
| 100-129
| 100-129
⚫
| 20 mL q6h
| 1280
| 1280
⚫
| 20 mL q6h
⚫
|2 DS tabs q6h
|}
|}


Line 79: Line 89:
{| class="wikitable"
{| class="wikitable"
! Weight (kg)
! Weight (kg)
⚫
! Dose (IV)
! Total dose TMP (mg/day)
! Total dose TMP (mg/day)
! Dose (IV)
!Dose (PO)
|-
|-
| 40-44
| 40-44
⚫
| 10 mL q6h
| 640
| 640
⚫
| 10 mL q6h
|1 DS tab q6h, or 2 DS tabs q12h
|-
|-
| 45-49
| 45-49
⚫
| 15 mL q8h
| 720
| 720
⚫
| 15 mL q8h
⚫
|3 SS tabs q8h
|-
|-
| 50-69
| 50-69
⚫
| 15 mL q6h
| 960
| 960
⚫
| 15 mL q6h
|2 DS tabs q8h, or 3 SS tabs q6h
|-
|-
| 70-79
| 70-79
⚫
| 25 mL q8h
| 1200
| 1200
⚫
| 25 mL q8h
|5 SS tabs q8h
|-
|-
| 80-89
| 80-89
⚫
| 20 mL q6h
| 1280
| 1280
⚫
| 20 mL q6h
⚫
|2 DS tabs q6h
|-
|-
| 90-99
| 90-99
⚫
| 30 mL q8h
| 1440
| 1440
⚫
| 30 mL q8h
|3 DS tabs q8h
|-
|-
| 100-109
| 100-109
⚫
| 25 mL q6h
| 1600
| 1600
⚫
| 25 mL q6h
|2/2/3/3 DS tabs q6h, or 5 SS tabs q6h
|-
|-
| 110-119
| 110-119
⚫
| 35 mL q8h
| 1680
| 1680
| 35 mL q8h
|7 SS tabs q8h
|-
|-
| 120-129
| 120-129
⚫
| 30 mL q6h
| 1920
| 1920
| 30 mL q6h
|3 DS tabs q6h
|}
|}


Line 123: Line 143:
{| class="wikitable"
{| class="wikitable"
! Weight (kg)
! Weight (kg)
⚫
! Total dose TMP (mg/day)
! Dose (IV)
! Dose (IV)
!Dose (PO)
⚫
! Total dose TMP (mg/day)
|-
|-
| 40-54
| 40-54
⚫
| 960
| 15 mL q6h
| 15 mL q6h
|2 DS tabs q8h, or 3 SS tabs q6h
⚫
| 960
|-
|-
| 55-69
| 55-69
⚫
| 1280
| 20 mL q6h
| 20 mL q6h
|2 DS tabs q6h
⚫
| 1280
|-
|-
| 70-79
| 70-79
⚫
| 30 mL q8h
| 1440
| 1440
| 30 mL q8h
|3 DS tabs q8h
|-
|-
| 80-89
| 80-89
⚫
| 25 mL q6h
| 1600
| 1600
| 25 mL q6h
|2/2/3/3 DS tabs q6h, or 5 SS tabs q6h
|-
|-
| 90-104
| 90-104
⚫
| 30 mL q6h
| 1920
| 1920
| 30 mL q6h
|3 DS tabs q6h
|-
|-
| 105-119
| 105-119
⚫
| 35 mL q6h
| 2240
| 2240
| 35 mL q6h
|3/3/4/4 DS tabs q6h, or 7 SS tabs q6h
|-
|-
| 120-134
| 120-134
⚫
| 40 mL q6h
| 2560
| 2560
| 40 mL q6h
|4 DS tabs q6h
|}
|}


Line 184: Line 212:


== Adverse Drug Reactions ==
== Adverse Drug Reactions ==
* Systemic allergic reactions
⚫
* Allergic reactions, including [[Adverse drug reaction::anaphylaxis]] and a relatively high rate of [[Adverse drug reaction::SJS]]/[[Adverse drug reaction::TEN]]
**[[Adverse drug reaction::Anaphylaxis]]
**[[Adverse drug reaction::Serum sickness]]
*Cutaneous reactions
⚫
**High rate of [[Adverse drug reaction::SJS]]/[[Adverse drug reaction::TEN]]
**Other non-specific rash
**[[Adverse drug reaction::Erythema multiforme]]
**[[Adverse drug reaction::Urticaria]]
**[[Adverse drug reaction::Photodermatitis]]
* [[Adverse drug reaction::GI upset]], including nausea at higher doses
* [[Adverse drug reaction::GI upset]], including nausea at higher doses
* [[Adverse drug reaction::Drug-drug interactions]]
* [[Adverse drug reaction::Drug-drug interactions]]
Line 192: Line 228:
* [[Adverse drug reaction::Hepatotoxicity]]
* [[Adverse drug reaction::Hepatotoxicity]]
* [[Adverse drug reaction::Hyperkalemia]]
* [[Adverse drug reaction::Hyperkalemia]]
*[[Adverse drug reaction::Hyponatremia]]
* [[Adverse drug reaction::Hypoglycemia]]
* [[Adverse drug reaction::Hypoglycemia]]
* [[Adverse drug reaction::Acute kidney injury]], though it also increases tubular creatinine reabsorption
* [[Adverse drug reaction::Acute kidney injury]], though it also increases tubular creatinine reabsorption

Revision as of 13:58, 30 March 2022

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: 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) Total dose TMP (mg/day) Dose (IV) Dose (PO)
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

TMP 15 mg/kg per day

Weight (kg) Total dose TMP (mg/day) Dose (IV) Dose (PO)
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

TMP 20 mg/kg per day

Weight (kg) Total dose TMP (mg/day) Dose (IV) Dose (PO)
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

Further Reading

  • Considerations when prescribing trimethoprim-sulfamethoxazole. CMAJ. 2011;183(16):1851-1858. doi: 10.1503/cmaj.111152
    • Review of adverse events
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