Trimethoprim-Sulfamethoxazole DS: Difference between revisions
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==General==
==General==
*Type: [[Sulfonamide]]
*Type: [[Is DrugClass::Sulfonamide]]
*Dosage Forms: 160/800; 40mg TMP/5mL
*Dosage Forms: 160/800; 40mg TMP/5mL
*Common Trade Names:  Bactrim DS
*Common Trade Names:  Bactrim DS
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==Adult Dosing==
==Adult Dosing==
===General===
===General===
1 tab (160mg TMP) PO Q12h
*1 tab (160mg TMP) PO Q12h


===[[PCP]] Prophylaxis===
80-160mg TMP PO daily


===[[PCP]] Treatment===
 
15-20mg/kg/day TMP PO divided q6-8h x 21 days
 
===Indications by Disease===
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|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
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==Pediatric Dosing==
==Pediatric Dosing==
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*Severe infection
*Severe infection
**15-20mg/kg/dy TMP PO divided q6-8h
**15-20mg/kg/dy TMP PO divided q6-8h
===Indications by Disease===
{{#ask: [[Has DrugName::Trimethoprim-Sulfamethoxazole DS]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
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==Special Populations==
==Special Populations==
*Pregnancy: D
*Pregnancy: [[Drug pregnancy categories|D]]
*Lactation: ?
*Lactation: ?
*Renal (Adult & Pediatric)
*Renal (Adult & Pediatric)
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*Megaloblastic anemia or folate deficiency
*Megaloblastic anemia or folate deficiency
*G6PD deficiency
*G6PD deficiency
*Pregnancy (class D)


==Adverse Reactions==
==Adverse Reactions==
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*Fulminant hepatic necrosis
*Fulminant hepatic necrosis
*Agranulocytosis
*Agranulocytosis
*Aplastic anemia
*[[Aplastic anemia]]
*Blood dyscrasias
*Blood dyscrasias
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
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*Pulmonary infiltrates
*Pulmonary infiltrates
*Myelosuppression
*Myelosuppression
*Methhemoglobinemia
*[[Methemoglobinemia]]
*[[Hyperkalemia]]
*[[Hyperkalemia]]
*[[Hyponatremia]]
*[[Hyponatremia]]
*Aseptic [[meningitis]]
*Aseptic [[meningitis]]
*[[Seizures]]
*[[Seizures]]
*Lupus Erythematosus
*[[Lupus Erythematosus]]
*[[Hypoglycemia]]
*[[Hypoglycemia]]
*[[Clostridium difficile]]
*[[Clostridium difficile]]
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===Key===
===Key===
{{Template:Antibacterial Spectra Key}}
{{Template:Antibacterial Spectra Key}}
==Comments==
'''Bactrim dosing is based on the trimethoprim part not the sulfamethoxazole part.'''
*The dosing in 8-10mg/kg of trimethoprim divided q12 hours (4-5 mg/kg per dose).
*The concentration of Bactrim is 200 mg of sulfamethoxazole and 40 mg of trimethoprim in 5 mL.
*Example: 10 kg child - 8mg/kg per day of trimethoprim part which is 80 mg per day. Divide by 2 = 40 mg of trimethoprim per dose. Based on the above concentration patient will get 5 mL of Bactrim 2 times per day.


==See Also==
==See Also==

Latest revision as of 11:07, 20 March 2026

General

  • Type: Sulfonamide
  • Dosage Forms: 160/800; 40mg TMP/5mL
  • Common Trade Names: Bactrim DS
  • Abbreviations: TMP-SMX, TMP-SMZ

Adult Dosing

General

  • 1 tab (160mg TMP) PO Q12h



Indications by Disease

DiseaseDoseContext
Acute cystitisDS (160/800mg) 1 tab BID x 3d (Females) x7days (Males)Outpatient, Women Uncomplicated
Acute diarrhea1 DS tab PO BID x 5 daysSalmonella
Acute diarrhea1 DS tab PO BID x 5 daysShigella
Acute diarrhea1 tablet (5mg/kg) PO BID daily x 3 dailyVibrio cholerae
Acute diarrhea1 DS tab (5mg/kg) PO BIDYersinia
Cellulitis2 DS tablets PO q12hrs x 10 daysFreshwater
CellulitisDS 1 tab PO BIDOutpatient, MRSA
Diabetic foot infection2DS tabs PO q12hrs daily x 14 daysModerate DFI
Diabetic foot infection2DS tabs PO q12hrs daily x 14 daysMild DFI
Diverticulitisone double-strength tablet BIDUncomplicated, PCN allergy
Felon2 DS tablets PO q12hrs x 7 daysOutpatient
Mammalian bites5mg/kg IV q12hrsSevere mammalian bite with Clindamycin
Mammalian bites2 DS tabs (5mg/kg) PO q12hrsCat and dog bites with Clindamycin
Mammalian bites2 DS tabs (5mg/kg) PO q12hrsHuman bites with Clindamycin
Periorbital cellulitis1-2 double-strength tablets BIDOutpatient
Pneumocystis jirovecii pneumonia2 DS tablets PO q8hrsMild disease
Pneumocystis jirovecii pneumonia5mg/kg IV q8hrs x 21 daysSevere disease
Pneumocystis jirovecii pneumonia1 DS tablet dailyProphylaxis
Prostatitis1 DS tablet PO q12hrs x 28 daysNon-STD/Chronic
Pyelonephritis160/800mg PO BID x14 daysOutpatient
Septic bursitis2 DS tabs PO two times daily x 14 daysOutpatient
Toxoplasmosis5mg/kg IV q12hrsImmunosuppressed alt

Pediatric Dosing

General (>2mo)

  • Mild-mod infection
    • 4-5mg/kg TMP PO q12hr
  • Severe infection
    • 15-20mg/kg/dy TMP PO divided q6-8h


Indications by Disease

DiseaseDoseContext
Acute cystitis6-12mg/kg/day (TMP) PO divided BID x 7-10 daysPediatric
Acute diarrhea8mg/kg/day (TMP) PO divided BID x 5 daysPediatric Salmonella
Acute diarrhea8mg/kg/day (TMP) PO divided BID x 5 daysPediatric Shigella
Cellulitis8-12mg/kg/day (TMP) PO divided BIDPediatric Outpatient, MRSA
Infectious tenosynovitis5mg/kg IV BIDPediatrics
Mammalian bites8-12mg/kg/day (TMP) PO divided BIDPediatric PCN allergy with Clindamycin
Mammalian bites8-12mg/kg/day (TMP) PO divided BIDPediatric Human bites with Clindamycin
Periorbital cellulitis8 to 12 mg/kg QD of the TMP component divided every 12 hoursOutpatient
Pertussis4mg/kg PO BID daily for 14 days>1 month old (if >2mo)
Pneumocystis jirovecii pneumonia5mg/kg (TMP) IV/PO q6-8hrs x 21 daysPediatric Treatment
Pneumocystis jirovecii pneumonia5mg/kg/day (TMP) PO divided BID 3 days/weekPediatric Prophylaxis
Pyelonephritis6-12mg/kg/day (TMP) PO divided BID x 10-14 daysPediatric Outpatient
Toxoplasmosis5mg/kg (TMP) PO/IV q12hrsPediatric Immunosuppressed alt

Special Populations

  • Pregnancy: D
  • Lactation: ?
  • Renal (Adult & Pediatric)
    • CrCl 15-30: Decrease dose by 50%
    • CrCl <15: Avoid use
    • Hemodialysis: Give supplement
    • Peritoneal Dialysis: No supplement
  • Hepatic (Adult & Pediatric)[1]
    • Mild-mod impairment: Caution advised
    • Significant impairment: Contraindicated

Contraindications

  • Allergy to class/drug
  • <2 months of age (except as PCP prophylaxis)
  • Significant hepatic impairment
  • Megaloblastic anemia or folate deficiency
  • G6PD deficiency
  • Pregnancy (class D)

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 6-12h (20-50h ESRD)
  • Metabolism:
    • Hepatic
  • Excretion:
    • Urine - both as unchanged drug and metabolites
  • Mechanism of Action: Bactericidal via interfering with folic acid synthesis

Antibiotic Sensitivities[2]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G X22
Strep. Pneumoniae S
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis X22
Enterococcus faecium R
MSSA S
MRSA S
CA-MRSA S
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis X2
Moraxella catarrhalis S
H. influenzae I
E. coli I
Klebsiella sp I
E. coli/Klebsiella ESBL+ I
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg X1
Enterobacter sp, AmpC pos X1
Serratia sp X1
Serratia marcescens I
Salmonella sp I
Shigella sp I
Proteus mirabilis S[3]
Proteus vulgaris S[4]
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. I
Pseudomonas aeruginosa R
Burkholderia cepacia S
Stenotrophomonas maltophilia S
Yersinia enterocolitica S
Francisella tularensis S
Brucella sp. X2
Legionella sp. S
Pasteurella multocida X1
Haemophilus ducreyi I
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis R
Prevotella melaninogenica X1
Clostridium difficile X1
Clostridium (not difficile) X1
Fusobacterium necrophorum X1
Peptostreptococcus sp. X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Comments

Bactrim dosing is based on the trimethoprim part not the sulfamethoxazole part.

  • The dosing in 8-10mg/kg of trimethoprim divided q12 hours (4-5 mg/kg per dose).
  • The concentration of Bactrim is 200 mg of sulfamethoxazole and 40 mg of trimethoprim in 5 mL.
  • Example: 10 kg child - 8mg/kg per day of trimethoprim part which is 80 mg per day. Divide by 2 = 40 mg of trimethoprim per dose. Based on the above concentration patient will get 5 mL of Bactrim 2 times per day.

See Also

References

  1. ↑ Trimethoprim-sulfamethoxazole (co-trimoxazole): Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.
  2. ↑ Sanford Guide to Antimicrobial Therapy 2014
  3. ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.
  4. ↑ GlobalRPH. Bactrim. Last revised 10/2009. http://www.globalrph.com/bactrim_dilution.htm.
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