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Medication Safety Issues
Sound-alike/look-alike issues:
Bactrim™ may be confused with bacitracin, Bactine®, Bactroban®
Co-trimoxazole may be confused with clotrimazole
Septra® may be confused with Ceptaz®, Sectral®
Septra® DS may be confused with Semprex®-D
Pronunciation
(sul fa meth OKS a zole & trye METH oh prim)
U.S. Brand Names
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Oral treatment of urinary tract infections due to E. coli, Klebsiella and Enterobacter sp, M. morganii, P. mirabilis and P. vulgaris; acute otitis media in children; acute exacerbations of chronic bronchitis in adults due to susceptible strains of H. influenzae or S. pneumoniae; treatment and prophylaxis of Pneumocystis jiroveci pneumonitis (PCP); traveler's diarrhea due to enterotoxigenic E. coli; treatment of enteritis caused by Shigella flexneri or Shigella sonnei
I.V. treatment or severe or complicated infections when oral therapy is not feasible, for documented PCP, empiric treatment of PCP in immune compromised patients; treatment of documented or suspected shigellosis, typhoid fever, Nocardia asteroides infection, or other infections caused by susceptible bacteria
Use: Unlabeled/Investigational
Cholera and Salmonella-type infections and nocardiosis; chronic prostatitis; as prophylaxis in neutropenic patients with P. jiroveci infections, in leukemia patients, and in patients following renal transplantation, to decrease incidence of PCP; treatment of Cyclospora infection, typhoid fever, Nocardia asteroides infection; prophylaxis against urinary tract infection
Pregnancy Risk Factor
C/D (at term - expert analysis)
Pregnancy Considerations
Do not use at term to avoid kernicterus in the newborn; use during pregnancy only if risks outweigh the benefits since folic acid metabolism may be affected.
Lactation
Enters breast milk/contraindicated (AAP rates “compatible with restrictions”)
Breast-Feeding Considerations
Sulfonamides are excreted in low concentrations in breast milk. Use during breast feeding in infants <2 months of age is contraindicated according to the manufacturer. The AAP considers use during breast-feeding “compatible” in full term neonates; however, breast-feeding is not recommended if the infant is ill, stressed, or premature or if the infant has glucose-6-phosphate dehydrogenase deficiency or hyperbilirubinemia.
Contraindications
Hypersensitivity to any sulfa drug, trimethoprim, or any component of the formulation; megaloblastic anemia due to folate deficiency; infants <2 months of age; marked hepatic damage or severe renal disease (if patient not monitored); pregnancy (at term); breast-feeding
Warnings/Precautions
Concerns related to adverse effects:
• Blood dyscrasias: Fatalities associated with severe reactions including agranulocytosis, aplastic anemia and other blood dyscrasias have occurred; discontinue use at first sign of rash or signs of serious adverse reactions.
• Dermatologic reactions: Fatalities associated with severe reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have occurred; discontinue use at first sign of rash.
• Hepatic necrosis: Fatalities associated with hepatic necrosis have occurred; discontinue use at first sign of rash or signs of serious adverse reactions.
• Hyperkalemia: May cause hyperkalemia (associated with high doses of trimethoprim).
• Hypoglycemia: May cause hypoglycemia, particularly in malnourished, or patients with renal or hepatic impairment.
• Sulfonamide allergy: Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Asthma/allergies: Use with caution in patients with allergies or asthma.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended. Maintain adequate hydration to prevent crystalluria.
• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.
Special populations:
• AIDS patients: Incidence of adverse effects appears to be increased in patients with AIDS.
• Elderly: Use with caution in the elderly; greater risk for more severe adverse reactions.
• G6PD deficiency: Use with caution in patients with G6PD deficiency; hemolysis may occur (dose-related).
• Patients with potential for folate deficiency: Use with caution in patients with potential folate deficiency (malnourished, chronic anticonvulsant therapy, or elderly).
• Slow acetylators: May be more prone to adverse reactions.
Dosage form specific issues:
• Injection vehicle: May contain benzyl alcohol which has been associated with "gasping syndrome" in neonates and sodium metabisulfite.
Adverse Reactions
The most common adverse reactions include gastrointestinal upset (nausea, vomiting, anorexia) and dermatologic reactions (rash or urticaria). Rare, life-threatening reactions have been associated with co-trimoxazole, including severe dermatologic reactions, blood dyscrasias, and hepatotoxic reactions. Most other reactions listed are rare, however, frequency cannot be accurately estimated.
Cardiovascular: Allergic myocarditis
Central nervous system: Apathy, aseptic meningitis, ataxia, chills, depression, fatigue, fever, hallucinations, headache, insomnia, kernicterus (in neonates), nervousness, peripheral neuritis, seizure, vertigo
Dermatologic: Photosensitivity, pruritus, rash, skin eruptions, urticaria; rare reactions include erythema multiforme, exfoliative dermatitis, Henoch-Schönlein purpura, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Endocrine & metabolic: Hyperkalemia (generally at high dosages), hypoglycemia (rare), hyponatremia
Gastrointestinal: Abdominal pain, anorexia, diarrhea, glottis, nausea, pancreatitis, pseudomembranous colitis, stomatitis, vomiting
Hematologic: Agranulocytosis, aplastic anemia, eosinophilia, hemolysis (with G6PD deficiency), hemolytic anemia, hypoprothrombinemia, leukopenia, megaloblastic anemia, methemoglobinemia, neutropenia, thrombocytopenia
Hepatic: Hepatotoxicity (including hepatitis, cholestasis, and hepatic necrosis), hyperbilirubinemia, transaminases increased
Neuromuscular & skeletal: Arthralgia, myalgia, rhabdomyolysis, weakness
Otic: Tinnitus
Renal: BUN increased, crystalluria, diuresis (rare), interstitial nephritis, nephrotoxicity (in association with cyclosporine), renal failure, serum creatinine increased, toxic nephrosis (with anuria and oliguria)
Respiratory: Cough, dyspnea, pulmonary infiltrates
Miscellaneous: Allergic reaction, anaphylaxis, angioedema, periarteritis nodosa (rare), serum sickness, systemic lupus erythematosus (rare)
Metabolism/Transport Effects
Sulfamethoxazole: Substrate of CYP2C9 (major), 3A4 (minor); Inhibits CYP2C9 (moderate)
Trimethoprim: Substrate (major) of CYP2C9, 3A4; Inhibits CYP2C8 (moderate), 2C9 (moderate)
Drug Interactions
ACE Inhibitors: Trimethoprim may enhance the hyperkalemic effect of ACE Inhibitors. Risk C: Monitor therapy
Angiotensin II Receptor Blockers: Trimethoprim may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Antidiabetic Agents (Thiazolidinedione): Trimethoprim may decrease the metabolism of Antidiabetic Agents (Thiazolidinedione). Risk C: Monitor therapy
Coumarin Derivatives: Sulfonamide Derivatives may enhance the anticoagulant effect of Coumarin Derivatives. Risk D: Consider therapy modification
CycloSPORINE: Sulfonamide Derivatives may enhance the nephrotoxic effect of CycloSPORINE. Sulfonamide Derivatives may decrease the serum concentration of CycloSPORINE. Risk C: Monitor therapy
CYP2C8 Substrates (High risk with Highly Effective Inhibitors): CYP2C8 Inhibitors (Moderate) may decrease the metabolism of CYP2C8 Substrates (High risk with Highly Effective Inhibitors). Risk C: Monitor therapy
CYP2C9 Inducers (Highly Effective): May increase the metabolism of CYP2C9 Substrates (High risk with Highly Effective Inducers). Risk C: Monitor therapy
CYP2C9 Inhibitors (Moderate): May decrease the metabolism of CYP2C9 Substrates (High risk with Highly Effective Inhibitors). Risk C: Monitor therapy
CYP2C9 Inhibitors (Strong): May decrease the metabolism of CYP2C9 Substrates (High risk with Highly Effective Inhibitors). Risk D: Consider therapy modification
CYP2C9 Substrates (High risk with Highly Effective Inhibitors): CYP2C9 Inhibitors (Moderate) may decrease the metabolism of CYP2C9 Substrates (High risk with Highly Effective Inhibitors). Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Dapsone: Trimethoprim may increase the serum concentration of Dapsone. Dapsone may increase the serum concentration of Trimethoprim. Risk C: Monitor therapy
Dofetilide: Trimethoprim may decrease the excretion of Dofetilide. Risk X: Avoid combination
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Lamivudine: Trimethoprim may decrease the excretion of Lamivudine. Risk C: Monitor therapy
Leucovorin-Levoleucovorin: May diminish the therapeutic effect of Trimethoprim. Risk D: Consider therapy modification
Methotrexate: Sulfonamide Derivatives may enhance the adverse/toxic effect of Methotrexate. Risk D: Consider therapy modification
Methotrexate: Trimethoprim may enhance the adverse/toxic effect of Methotrexate. Risk D: Consider therapy modification
Phenytoin: Sulfonamide Derivatives may decrease the metabolism of Phenytoin. Risk C: Monitor therapy
Phenytoin: Trimethoprim may decrease the metabolism of Phenytoin. Risk C: Monitor therapy
Procainamide: Trimethoprim may decrease the excretion of Procainamide. Risk D: Consider therapy modification
Procaine: May diminish the therapeutic effect of Sulfonamide Derivatives. Risk X: Avoid combination
Repaglinide: Trimethoprim may decrease the metabolism of Repaglinide. Risk C: Monitor therapy
Sulfonylureas: Sulfonamide Derivatives may enhance the hypoglycemic effect of Sulfonylureas. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: Avoid dong quai; St John's wort (may diminish effects and also cause photosensitization).
Storage
Injection: Store at room temperature; do not refrigerate. Less soluble in more alkaline pH. Protect from light. Solution must be diluted prior to administration. Following dilution, store at room temperature; do not refrigerate. Manufacturer recommended dilutions and stability of parenteral admixture at room temperature (25°C):
5 mL/125 mL D5W; stable for 6 hours.
5 mL/100 mL D5W; stable for 4 hours.
5 mL/75 mL D5W; stable for 2 hours.
Studies have also confirmed limited stability in NS; detailed references should be consulted.
Suspension, tablet: Store at controlled room temperature of 15°C to 25°C (59°F to 77°F). Protect from light.
Compatibility
Stable in D51/2NS, LR, 1/2NS; variable stability (consult detailed reference) in D5W, NS.
Y-site administration: Compatible: Acyclovir, aldesleukin, allopurinol, amifostine, amphotericin B cholesteryl sulfate complex, atracurium, aztreonam, bivalirudin, cefepime, cyclophosphamide, dexmedetomidine, diltiazem, docetaxel, doxorubicin liposome, enalaprilat, esmolol, etoposide phosphate, fenoldopam, filgrastim, fludarabine, gallium nitrate, gatifloxacin, gemcitabine, granisetron, hydromorphone, labetalol, linezolid, lorazepam, magnesium sulfate, melphalan, meperidine, morphine, nicardipine, pancuronium, pemetrexed, perphenazine, piperacillin/tazobactam, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, vecuronium, zidovudine. Incompatible: Fluconazole, midazolam, vinorelbine. Variable (consult detailed reference): Cisatracurium, foscarnet.
Compatibility in syringe: Compatible: Dimenhydramine, heparin. Incompatible: Pantoprazole.
Compatibility when admixed: Incompatible: Fluconazole, linezolid, verapamil.
Mechanism of Action
Sulfamethoxazole interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation from para-aminobenzoic acid; trimethoprim inhibits dihydrofolic acid reduction to tetrahydrofolate resulting in sequential inhibition of enzymes of the folic acid pathway
Pharmacodynamics/Kinetics
Absorption: Oral: Almost completely, 90% to 100%
Protein binding: SMX: 68%, TMP: 45%
Metabolism: SMX: N-acetylated and glucuronidated; TMP: Metabolized to oxide and hydroxylated metabolites
Half-life elimination: SMX: 9 hours, TMP: 6-17 hours; both are prolonged in renal failure
Time to peak, serum: Within 1-4 hours
Excretion: Both are excreted in urine as metabolites and unchanged drug
Effects of aging on the pharmacokinetics of both agents has been variable; increase in half-life and decreases in clearance have been associated with reduced creatinine clearance
Dosage
Dosage recommendations are based on the trimethoprim component. Double-strength tablets are equivalent to sulfamethoxazole 800 mg and trimethoprim 160 mg.
Usual dosage ranges:
Children >2 months:
Mild-to-moderate infections: Oral: 8-12 mg TMP/kg/day in divided doses every 12 hours
Serious infection:
Oral: 20 mg TMP/kg/day in divided doses every 6 hours
I.V.: 8-12 mg TMP/kg/day in divided doses every 6 hours
Adults:
Oral: One double strength tablet (sulfamethoxazole 800 mg; trimethoprim 160 mg) every 12-24 hours
I.V.: 8-20 mg TMP/kg/day divided every 6-12 hours
Indication-specifc dosing:
Children >2 months:
Acute otitis media: Oral: 8 mg TMP/kg/day in divided doses every 12 hours for 10 days. Note: Recommended by the American Academy of Pediatrics as an alternative agent in penicillin-allergic patients at a dose of 6-10 mg TMP/kg/day (AOM guidelines, 2004).
Urinary tract infection:
Treatment:
Oral: 6-12 mg TMP/kg/day in divided doses every 12 hours
I.V.: 8-10 mg TMP/kg/day in divided doses every 6, 8, or 12 hours for up to 14 days with serious infections
Prophylaxis: Oral: 2 mg TMP/kg/dose daily or 5 mg TMP/kg/dose twice weekly
Pneumocystis jiroveci:
Treatment: Oral, I.V.: 15-20 mg TMP/kg/day in divided doses every 6-8 hours
Prophylaxis: Oral, 150 mg TMP/m2/day in divided doses every 12 hours for 3 days/week; dose should not exceed trimethoprim 320 mg and sulfamethoxazole 1600 mg daily
Alternative prophylaxis dosing schedules include:
150 mg TMP/m2/day as a single daily dose 3 times/week on consecutive days
or
150 mg TMP/m2/day in divided doses every 12 hours administered 7 days/week
or
150 mg TMP/m2/day in divided doses every 12 hours administered 3 times/week on alternate days
Shigellosis:
Oral: 8 mg TMP/kg/day in divided doses every 12 hours for 5 days
I.V.: 8-10 mg TMP/kg/day in divided doses every 6, 8, or 12 hours for up to 5 days
Cyclospora
(unlabeled use): Oral, I.V.: 5 mg TMP/kg twice daily for 7-10 days
Adults:
Urinary tract infection:
Oral: One double-strength tablet every 12 hours
Duration of therapy: Uncomplicated: 3-5 days; Complicated: 7-10 days
Pyelonephritis: 14 days
Prostatitis: Acute: 2 weeks; Chronic: 2-3 months
I.V.: 8-10 mg TMP/kg/day in divided doses every 6, 8, or 12 hours for up to 14 days with severe infections
Chronic bronchitis (acute): Oral: One double-strength tablet every 12 hours for 10-14 days
Meningitis (bacterial): I.V.: 10-20 mg TMP/kg/day in divided doses every 6-12 hours
Shigellosis:
Oral: One double strength tablet every 12 hours for 5 days
I.V.: 8-10 mg TMP/kg/day in divided doses every 6, 8, or 12 hours for up to 5 days
Travelers' diarrhea: Oral: One double strength tablet every 12 hours for 5 days
Sepsis: I.V.: 20 TMP/kg/day divided every 6 hours
Pneumocystis jiroveci
:
Prophylaxis: Oral: 1 double strength tablet daily or 3 times/week
Treatment: Oral, I.V.: 15-20 mg TMP/kg/day in 3-4 divided doses
Cyclospora
(unlabeled use): Oral, I.V.: 160 mg TMP twice daily for 7-10 days. Note: AIDS patients: Oral: 1 double strength tablet 2-4 times/day for 10 days, then 1 double strength tablet 3 times/week for 10 weeks (Verdier, 2000 and Pape, 1994).
Nocardia
(unlabeled use): Oral, I.V.:
Cutaneous infections: 5-10 mg TMP/kg/day in 2-4 divided doses
Severe infections (pulmonary/cerebral): 15 mg TMP/kg/day in 2-4 divided doses for 3-4 weeks, then 10 mg TMP/kg/day in 2-4 divided doses. Treatment duration is controversial; an average of 7 months has been reported.
Note: Therapy for severe infection may be initiated I.V. and converted to oral therapy (frequently converted to approximate dosages of oral solid dosage forms: 2 DS tablets every 8-12 hours). Although not widely available, sulfonamide levels should be considered in patients with questionable absorption, at risk for dose-related toxicity, or those with poor therapeutic response.
Dosing adjustment in renal impairment: Oral, I.V.:
Clcr 15-30 mL/minute: Administer 50% of recommended dose
Clcr <15 mL/minute: Use is not recommended
Administration: Oral
May be taken with or without food. Administer with at least 8 ounces of water.
Administration: I.V.
Infuse over 60-90 minutes, must dilute well before giving.
Administration: I.V. Detail
May be given less diluted in a central line. Not for I.M. injection. Administer around-the-clock every 6-12 hours.
pH: 10
Monitoring Parameters
Perform culture and sensitivity testing prior to initiating therapy; CBC, serum potassium, creatinine, BUN
Test Interactions
Increased creatinine (Jaffé alkaline picrate reaction); increased serum methotrexate by dihydrofolate reductase method
Dietary Considerations
Should be taken with 8 oz of water.
Patient Education
See individual agent for Trimethoprim.
Geriatric Considerations
Elderly patients appear at greater risk for more severe adverse reactions.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Stomatitis.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Rarely may cause depression, hallucination, or confusion; sulfonamides may cause euphoria, restlessness, irritability, disorientation, panic, and delusions
Mental Health: Effects on Psychiatric Treatment
May rarely cause granulocytopenia; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
See individual agent for Trimethoprim.
Oncology: Vesicant
No
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Note: The 5:1 ratio (SMX:TMP) remains constant in all dosage forms.
Injection, solution: Sulfamethoxazole 80 mg and trimethoprim 16 mg per mL (5 mL, 10 mL, 30 mL)
Suspension, oral: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (480 mL)
Sulfatrim®: Sulfamethoxazole 200 mg and trimethoprim 40 mg per 5 mL (100 mL, 480 mL) [contains alcohol ?0.5% propylene glycol; cherry flavor]
Tablet: Sulfamethoxazole 400 mg and trimethoprim 80 mg
Bactrim™: Sulfamethoxazole 400 mg and trimethoprim 80 mg
Septra®: Sulfamethoxazole 400 mg and trimethoprim 80 mg
Tablet, double strength: Sulfamethoxazole 800 mg and trimethoprim 160 mg
Bactrim™ DS: Sulfamethoxazole 800 mg and trimethoprim 160 mg
Septra® DS: Sulfamethoxazole 800 mg and trimethoprim 160 mg
Pricing: U.S. (www.drugstore.com)
Suspension (Sulfamethoxazole-Trimethoprim)
200-40 mg/5 mL (200): $18.98
Suspension (Sulfatrim)
200-40 mg/5 mL (480): $33.98
Tablets (Bactrim)
400-80 mg (30): $37.54
Tablets (Septra)
400-80 mg (40): $66.12
Tablets (Septra DS)
800-160 mg (30): $69.99
Tablets (Sulfamethoxazole-TMP DS)
800-160 mg (30): $19.99
Tablets (Sulfamethoxazole-Trimethoprim)
400-80 mg (30): $15.99
References
“1997 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected With Human Immunodeficiency Virus. USPHS/IDSA Prevention of Opportunistic Working Group,” MMWR Recomm Rep, 1997, 46(RR-12):1-46.
“American Academy of Pediatrics and American Academy of Family Physicians. Diagnosis and Management of Acute Otitis Media,” Pediatrics, 2004, 113(5):1451-65.
“American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk,” Pediatrics, 2001, 108(3):776-89.
Bissuel F, Cotte L, Crapanne JB, et al, “Trimethoprim-Sulphamethoxazole Rechallenge in 20 Previously Allergic HIV-Infected Patients After Homeopathic,” AIDS, 1995, 9(4):407-8.
Choo V, “UK Revises Indications for Co-Trimoxazole,” Lancet, 1995, 346:175.
Cockerill FR and Edson RS, “Trimethoprim-Sulfamethoxazole,” Mayo Clin Proc, 1991, 66(12):1260-9.
Cook DE and Ponte CD, “Suspected Trimethoprim/Sulfamethoxazole-Induced Hypoprothrombinemia,” J Fam Pract, 1994, 39(6):589-91.
Dawkins B, Albury D, and Olsen TE, “Trimethoprim/Sulfamethoxazole-Induced Thrombocytopenia - A Case Report Supported by the Laboratory Diagnosis,” Aust N Z J Med, 1995, 25:83.
Domingo P, Ferrer S, Cruz J, et al, “Trimethoprim-Sulfamethoxazole-Induced Renal Tubular Acidosis in a Patient With AIDS,” Clin Infect Dis, 1995, 20(5):143, 45-7.
Fischl MA, Dickinson GM, and La Voie L, “Safety and Efficacy of Sulfamethoxazole and Trimethoprim Chemoprophylaxis for Pneumocystis carinii Pneumonia in AIDS,” JAMA, 1988, 259(8):1185-9.
Gilbert DN, Moellering RC, Eliopoulos GM, et al, eds, The Sanford Guide To Antimicrobial Therapy, 2006, 36th ed, Hyde Park, VT: Antimicrobial Therapy, Inc, 2006, 6-7.
Hennessy S, Strom BL, Berlin JA, et al, “Predicting Cutaneous Hypersensitivity Reactions to Co-Trimoxazole in HIV-Infected Individuals Receiving Primary Pneumocystis carinii Pneumonia Prophylaxis,” J Gen Intern Med, 1995, 10(7):380-6.
Hughes W, Leoung G, Kramer F, et al, “Comparison of Atovaquone (566C80) With Trimethoprim-Sulfamethoxazole to Treat Pneumocystis carinii Pneumonia in Patients With AIDS,” N Engl J Med, 1993, 328(21):1521-7.
Hughes WT, “Pneumocystis carinii Pneumonia: New Approaches to Diagnosis, Treatment, and Prevention,” Pediatr Infect Dis J, 1991, 10(5):391-9.
Jick H and Derby LE, “A Large Population-Based Follow-Up Study of Trimethoprim-Sulfamethoxazole, Trimethoprim, and Cephalexin for Uncommon Serious Drug Toxicity,” Pharmacotherapy, 1995, 15(4):428-32.
Jick H and Derby LE, “Is Co-Trimoxazole Safe?” Lancet, 1995, 345(8957):1118-9.
Lerner PI, "Nocardiosis," Clinical Infectious Disease, 1996, 22(6):891-903.
Lundstrom TS and Sobel JD, “Vancomycin, Trimethoprim-Sulfamethoxazole, and Rifampin,” Infect Dis Clin North Am, 1995, 9(3):747-67.
Masur H, “Prevention and Treatment of Pneumocystis Pneumonia,” N Engl J Med, 1992, 327(26):1853-60.
Naber K, Vergin H, and Weigand W, “Pharmacokinetics of Co-trimoxazole and Co-tetroxazine in Geriatric Patients,” Infection, 1981, 9(5):239-43.
Noto H, Kaneko Y, Takano T, et al, “Severe Hyponatremia and Hyperkalemia Induced by Trimethoprim-Sulfamethoxazole in Patients With Pneumocystis carinii Pneumonia,” Intern Med, 1995, 34(2):96-9.
Pape JW, Verdier RI, Boncy M, et al, “Cyclospora Infection in Adults Infected with HIV. Clinical Manifestations, treatment, and Prophylaxis,” Ann Intern Med, 1994, 121(9):654-7.
“Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection,” Pediatrics, 1999, 103(4 Pt 1: 843-52.
Sattler FR, Cowan R, Nielsen DM, et al, “Trimethoprim-Sulfamethoxazole Compared With Pentamidine for Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome,” Ann Intern Med, 1988, 109(4):280-7.
Singh N, Gayowski T, Yu VL, et al, “Trimethoprim-Sulfamethoxazole for the Prevention of Spontaneous Bacterial Peritonitis in Cirrhosis: A Randomized Trial,” Ann Intern Med, 1995, 122(8):595-8.
Torre D, Casari S, Speranza F, et al, “Randomized Trial of Trimethoprim-Sulfamethoxazole Versus Pyrimethamine-Sulfadiazine for Therapy of Toxoplasmic Encephalitis in Patients With AIDS. Italian Collaborative Study Group,” Antimicrob Agents Chemother, 1998, 42(6):1346-9.
Tunkel AR, Hartman BJ, Kaplan SL, et al, “Practice Guidelines for the Management of Bacterial Meningitis,” Clin Infect Dis, 2004, 39(9):1267-84.
Varoquaux O, Lajoie D, Gobert C, et al, “Pharmacokinetics of the Trimethoprim-Sulfamethoxazole Combination in the Elderly,” Br J Clin Pharmacol, 1985, 20(6):575-81.
Verdier RI, Fritzgerald DW, Johnson WD, et al, “ Trimethoprim-Sulfamethoxazole Compared With Ciprofloxacin for Treatment and Prophylaxis of Isospora belli and Cyclospora cayetanensis Infection in HIV-Infected Patients,” Ann Intern Med, 2000, 132(11):885-8.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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