{"id":3859,"date":"2025-03-31T18:11:51","date_gmt":"2025-03-31T18:11:51","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/co-trimoxazole-txt\/"},"modified":"2025-03-31T18:11:51","modified_gmt":"2025-03-31T18:11:51","slug":"co-trimoxazole-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/co-trimoxazole-txt\/","title":{"rendered":"Co trimoxazole.txt"},"content":{"rendered":"

Co trimoxazole<\/h1>\n

CLINICAL USE <\/H3>
\nAntibacterial agent:Treatment and prophylaxis of Pneumocystis jiroveci pneumonia (PCP)Acute exacerbations of chronic bronchitis Urinary tract infections, on microbiological advice

DOSE IN NORMAL RENAL FUNCTION <\/H3>PCP: 120 mg\/kg\/day in 2\u20134 divided doses Oral prophylaxis: 480\u2013960 mg daily or 960 mg on alternate daysAcute exacerbations of chronic bronchitis and urinary tract infections on microbiological advice:IV: 960 mg \u2013 1.44 g of co-trimoxazole twice a dayOral: 960 mg of co-trimoxazole twice a day

PHARMACOKINETICS <\/H3>
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Sulfamethoxazole: 253.3; trimethoprim: 290.3<\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Sulfamethoxazole: 70; trimethoprim: 45<\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp : Sulfamethoxazole: 15\u201330; trimethoprim: 40\u201360<\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp :Sulfamethoxazole: 0.28\u20130.38; trimethoprim: 1\u20132.2<\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp :Sulfamethoxazole: 6\u201312\/
  • 20 to 50<\/LI>; trimethoprim: 8\u201310\/20\u201349

    DOSE IN RENAL IMPAIRMENT <\/H3>

    GFR (mL\/MIN)<\/H4>30\u201350 Dose as in normal renal function 15\u201330 50% of dose; PCP: 60 mg\/kg twice daily for 3 days then 30 mg\/kg twice daily<15 50% of dose; PCP: 30 mg\/kg twice daily. (This should only be given if haemodialysis facilities are available)

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR<15 mL\/min<\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR<15 mL\/min
  • HDF\/high flux &nbsp :Dialysed. Dose as in GFR<15 mL\/min
  • CAV\/VVHD &nbsp &nbsp &nbsp:Dialysed. Dose as in GFR=15\u201330 mL\/min

    IMPORTANT DRUG INTERACTIONS <\/H3>Potentially hazardous interactions with other drugsAnti-arrhythmics: increased risk of ventricular arrhythmias with amiodarone \u2013 avoid concomitant use; concentration of procainamide increasedAntibacterials: increased risk of crystalluria with methenamineAnticoagulants: effect of coumarins enhancedAnti-epileptics: antifolate effect and concentration of phenytoin increasedAntimalarials: increased risk of antifolate effect with pyrimethamineAntipsychotics: avoid concomitant use with clozapine, increased risk of agranulocytosisCiclosporin: increased risk of nephrotoxicity; possibly reduced ciclosporin levelsCytotoxics: increased risk of haematological toxicity with azathioprine and mercaptopurine. Antifolate effect of methotrexate increased

    ADMINISTRATION <\/H3>

    Reconstition<\/H4>\u2013

    Route <\/H4>IV, oral

    Rate of Administration <\/H4>Over 60\u201390 minutes Alternatively: 2\u20133 hours for high doses as undiluted solution via central line (unlicensed).Co-TriMoXAZoLE (TriMEThoPriM + sULFAMEThoXAZoLE) 191

    Comments<\/H4>For an

    IV infusion <\/H4> dilute each 5 mL co- trimoxazole strong solution with 125 mL sodium chloride 0.9% or glucose 5%Glaxo Smith Kline: dilute 5 mL to 75 mL glucose 5% and administer over 1 hour if fluid restricted

    OTHER INFORMATION <\/H4>Alternative dosing (for acute exacerbations of chronic bronchitis and urinary tract infections) on microbiological advice only; not PCPAfter 2\u20133 days, plasma samples collected 12 hours post dose should have levels of sulfamethoxazole not higher than 150 micrograms\/mL. If higher, stop treatment until levels fall below 120 micrograms\/mL. Plasma levels of trimethoprim should be 5 micrograms\/mL or higher, for optimum efficacy for PCPFolic acid supplementation may be necessary during chronic therapy. Monthly blood counts advisable
    \n","protected":false},"excerpt":{"rendered":"

    Co trimoxazole CLINICAL USE Antibacterial agent:Treatment and prophylaxis of Pneumocystis<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-3859","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3859","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=3859"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/3859\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=3859"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=3859"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=3859"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}