Adult Dosing
Bacterial infections caused by susceptible bacteria
- 800 mg/160 mg (sulfamethoxazole/trimethoprim) PO bid
- Duration of treatment is 5 days for shigellosis; 10-14 days for chronic bronchitis and UTI's
Pneumocystis cariini treatment
- 15-20 mg/kg/day (based on the trimethoprim component) PO divided qid for 2-3 wks
Pneumocystis cariini prophylaxis
- 800 mg/160 mg (sulfamethoxazole/trimethoprim) PO daily
Traveler's diarrhea
- 800 mg/160 mg (sulfamethoxazole/trimethoprim) PO bid for 5 days
Acute bronchitis [Not FDA Approved]
- 1 DS tablet (800/160 mg Sulfamethoxazole/trimethoprim ) PO bid for 5-10 days
Bronchiectasis [Not FDA Approved]
- 800 mg/160 mg PO bid X 10–14 days
Pediatric Dosing
Bacterial infections caused by susceptible bacteria
- >2 months: 40 mg/kg/day; 8 mg/kg/day (sulfamethoxazole/trimethoprim) PO divided bid
- Duration of treatment is 5 days for shigellosis; 10-14 days for otitis media and UTI's
Pneumocystis cariini treatment
- >2 months: 15-20 mg/kg/day (based on the trimethoprim component) PO divided qid for 14-21 days
Pneumocystis cariini prophylaxis
- >2 months: 750 mg/m2/day; 150 mg/m2/day; (sulfamethoxazole/trimethoprim) PO divided bid on 3 consecutive days each week. [Max: 1600 mg/320 mg/day (sulfamethoxazole/trimethoprim)]
Acute bronchitis [Not FDA Approved]
- 8-12 mg/kg/day divided bid based upon the trimethoprim component
Bronchiectasis [Not FDA Approved]
- Children
2 months: 40 mg/kg/day (sulfamethoxazole component) and 8 mg/kg/day (trimethoprim component) PO divided bid X 10 days
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >30 mL/min: Follow regular dosing guidelines
- 15-30 mL/min: Reduce dose by 50%
- <15 mL/min: Use not recommended
Hepatic Dose Adjustment
- Mild to moderate impairment: Use with caution
- Severe impairment: Contraindicated
- Clostridium difficile-associated diarrhea (CDAD) has been reported with use the drug and may range in severity from mild diarrhea to fatal colitis
- Sulfonamides can cause Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatotoxicity, blood dyscrasias, hemolysis in G6PD deficiency
- Sulfonamides, including sulfonamides containing products should be discontinued at the first appearance of a skin rash or any sign of adverse reaction
- Do not prescribe therapy in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication
- 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
- 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
- Coadministration with leucovorin for the treatment of HIV positive patients with Pneumocystis jiroveci pneumonia resulted in treatment failure and excess mortality in a randomized placebo controlled trial hence avoid coadministration
- Therapy during pregnancy may be associated with an increased risk of congenital malformations, particularly neural tube defects, cardiovascular malformations, urinary tract defects, oral clefts, and club foot
- Sulfonamides should not be used to treat group A beta-hemolytic streptococcal infections as they will not eradicate streptococcus or prevent rheumatic fever
- Severe life threatening cases of immune-mediated thrombocytopenia have been reported
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- History of bronchial asthma
- Chronic alcohol use
- Concomitant anticonvulsant therapy
- Malnutrition
- Debilitated patients
- Hyperkalemia
- Geriatric population
Pregnancy Category:C
Breastfeeding: In full term healthy infants, sulfamethoxazole/trimethoprim combination drug is considered acceptable for use, after the new born period. However alternative agents may be preferred in stressed, premature, jaundiced 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 manufacturer's data, use is contraindicated while breastfeeding.
US Trade Name(s)
- Bactrim
- Bactrim DS
- Septra
- Septra DS
- Sulfamethoprim
- Sulfamethoprim DS
- Sulfatrim
US Availability
sulfamethoxazole/trimethoprim (generic)
- TABS:
- 400 mg/80 mg
- 800 mg/160 mg
Bactrim, Septra, Sulfamethoprim (sulfamethoxazole/trimethoprim)
Bactrim DS, Septra DS, Sulfamethoprim DS (sulfamethoxazole/trimethoprim)
Sulfatrim (sulfamethoxazole/trimethoprim)
Canadian Trade Name(s)
- Apo sulfatrim
- Novo-trimel
- Nu-Cotrimox
- Protrin
- Trisulfa
Canadian Availability
Apo sulfatrim (sulfamethoxazole/trimethoprim)
- TABS:
- 100 mg/20 mg
- 400 mg/80 mg
- 800 mg/160 mg
Novo-trimel, Nu-Cotrimox, Trisulfa (sulfamethoxazole/trimethoprim)
- TABS:
- 400 mg/80 mg
- TABS: 800 mg/160 mg
Protrin (sulfamethoxazole/trimethoprim)
- TABS:
- 400 mg/80 mg
- 800 mg/160 mg
UK Trade Name(s)
UK Availability
Co-trimoxazole (sulfamethoxazole/trimethoprim)
Septrin (sulfamethoxazole/trimethoprim)
- TABS:
- 400 mg/80 mg
- 800 mg/160 mg
- SUSP:
- [200/40] mg/5 mL
- [400/80] mg/5 mL
Australian Trade Name(s)
Australian Availability
sulfamethoxazole/trimethoprim (generic)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Bactrim DS 800-160 MG TABS [Bottle] (AR SCIENTIFIC)
30 mg = $89.99
90 mg = $257.96 - Bactrim 400-80 MG TABS [Bottle] (AR SCIENTIFIC)
30 mg = $49.99
90 mg = $142.97 - Septra DS 800-160 MG TABS [Bottle] (MONARCH PHARMACEUTICALS)
30 mg = $72.79
90 mg = $203.82
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
