Adult Dosing
Pneumocystis Carinii Pneumonia
- Total daily dose: 15-20 mg/kg IV given in 3-4 equally divided doses q6-8 hrs x 14 days
Severe Urinary Tract Infections and Shigellosis
- Total daily dose: 8-10 mg/kg IV given in 2-4 divided doses q6-8 hrs or q12 hrs x 14 days for severe UTI and 5 days for shigellosis
- Max: 60 mL/day
Notes:- Sulfamethoxazole/trimethoprim IV injection should be diluted prior to administration in 5% dextrose in water solution. Do not mix therapy with other drugs or solutions. Avoid rapid infusion or bolus injection
- Sulfamethoxazole/trimethoprim should be given by IV infusion over a period of 60-90 minutes
Orbital cellulitis [Non-FDA Approved]
Pediatric Dosing
Pneumocystis Carinii Pneumonia
Children >2 months
- Total daily dose: 15-20 mg/kg IV given in 3-4 equally divided doses q6-8 hrs x 14 days
Severe Urinary Tract Infections and Shigellosis
Children >2 months
- Total daily dose: 8-10 mg/kg IV given in 2-4 divided doses q6-8 hrs or q12 hrs x 14 days for severe UTI and 5 days for shigellosis
- Max: 60 mL/day
Notes:- Therapy is contraindicated in infants <2 months of age
- Sulfamethoxazole/trimethoprim IV injection should be diluted prior to administration in 5% dextrose in water solution. Do not mix therapy with other drugs or solutions. Avoid rapid infusion or bolus injection
- Sulfamethoxazole/trimethoprim should be given by IV infusion over a period of 60-90 minutes
Orbital cellulitis [Non-FDA Approved]
- 8-10 mg/kg/day IV divided q12h [Max 800 Sulfa/160 TMP mg bid]
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Renal impairment
- >30 mL/min: Follow regular dosing guidelines
- 15-30 mL/min: Reduce dose by 50%
- <15 mL/min: Use not recommended
Hepatic Dose Adjustment
- Hepatic impairment
- Mild to moderate impairment: Use with caution
- Severe impairment: Contraindicated
See Supplemental Patient Information
- Sulfonamides may cause Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, hepatotoxicity, agranulocytosis, aplastic anemia, and other blood dyscrasias
- Sulfonamide-containing products should be discontinued at the first appearance of a skin rash or any sign of adverse reaction. Clinical signs including rash, fever, sore throat, pallor, purpura, jaundice or arthralgia may be early indications of serious reactions
- Cough, shortness of breath, and pulmonary infiltrates are hypersensitivity reactions of the respiratory tract that have been reported in association with sulfonamide treatment
- Avoid sulfonamides for the treatment of group A beta-hemolytic streptococcal infections
- Clostridium difficile associated diarrhea (CDAD) has been reported with sulfamethoxazole/trimethoprim injection and may range in severity from mild diarrhea to fatal colitis. Therapy with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile
- Sulfamethoxazole/trimethoprim injection contains sodium metabisulfite, which may cause allergic-type reactions, such as anaphylactic symptoms and life-threatening asthmatic episodes in certain susceptible individuals; this reaction is more frequent in asthmatic people
- Do not prescribe therapy in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication as it increases the risk of development of drug-resistant bacteria
- Use with caution in patients with impaired renal or hepatic function, severe allergies or bronchial asthma
- Rarely, therapy may cause hypoglycemia in non-diabetic patients, particularly in patients with renal dysfunction, liver disease, malnutrition, and those receiving high doses of therapy
- In elderly patients or in patients with preexisting folic acid deficiency or kidney failure, hematological changes indicative of folic acid deficiency may occur
- Caution advised in patients with porphyria or thyroid dysfunction
- Local irritation and inflammation due to extravascular infiltration have been reported with therapy; discontinue therapy and restart at another site if such events occur
- Severe skin reactions, generalized bone marrow suppression, hyperkalemia, and a specific decrease in platelets have been frequently observed in elderly patients receiving sulfamethoxazole/trimethoprim injections. Increased incidence of thrombocytopenia with purpura has been reported in patients who are concurrently receiving certain diuretics, primarily thiazides
- Therapy may increase the incidence of rash, fever, leukopenia, and elevated aminotransferase (transaminase) values in AIDS patients who are being treated for Pneumocystis carinii pneumonia
- CBC, urinalyses with careful microscopic examination, and renal function tests should be performed during therapy, particularly for those patients with impaired renal function
Caution: Use cautiously in
- Hepatic impairment
- Renal impairment
- Chronic alcohol use
- Concomitant anticonvulsant use
- Bone marrow suppressants
- Bronchial asthma
- Severe allergies
- Hyperkalemia
- Malnutrition
- Malabsorption
- Elderly patients
Supplemental Patient Information
- Instruct patients to maintain an adequate fluid intake in order to prevent crystalluria and stone formation
- Advise patients to promptly consult their physician if they develop watery and blood stools after starting treatment and even as late as two or more months after completing the last dose of therapy
Pregnancy Category:C
Breastfeeding: In full-term healthy infants, sulfamethoxazole/trimethoprim combination drug is considered acceptable for use after the newborn period. However, alternative agents may be preferred in stressed, premature, jaundiced or ill infants due to the risk of bilirubin displacement and kernicterus. This drug should be avoided while breastfeeding a G6PD-deficient infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). Sulfamethoxazole/trimethoprim is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 4 May 2011). According to the manufacturer's data, use is contraindicated while breastfeeding.
US Trade Name(s)
US Availability
sulfamethoxazole/trimethoprim (generic)
- INJ: [80 mg/16 mg]/mL (5, 10, 30 mL vial)
Canadian Trade Name(s)
Canadian Availability
Septra (sulfamethoxazole/trimethoprim)
- INJ: [80 mg/16 mg]/mL (5 mL amp)
UK Trade Name(s)
UK Availability
Septrin (sulfamethoxazole/trimethoprim)
- INJ: [80 mg/16 mg]/mL (5 mL amp)
Australian Trade Name(s)
Australian Availability
sulfamethoxazole/trimethoprim (generic)
- INJ: [80 mg/16 mg]/mL (5 mL amp)
[Outline]
