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Author: Admin | 2025-04-28
HomeCo-trimoxazole Brand names: Bactrim, Bactrim DS, Septra, Septra DS, SulfatrimDrug class: Sulfonamides- Antiprotozoal AgentsVA class: AM900CAS number: 8064-90-2 IntroductionUsesDosageWarningsInteractionsStabilityFAQ IntroductionAntibacterial; fixed combination of sulfamethoxazole (intermediate-acting sulfonamide) and trimethoprim; both sulfamethoxazole and trimethoprim are folate-antagonist anti-infectives.Uses for Co-trimoxazoleAcute Otitis MediaTreatment of acute otitis media (AOM) in adults† [off-label] and children caused by susceptible Streptococcus pneumoniae or Haemophilus influenzae when the clinician makes the judgment that the drug offers some advantage over use of a single anti-infective. Not a drug of first choice; considered an alternative for treatment of AOM, especially for those with type I penicillin hypersensitivity. Because amoxicillin-resistant S. pneumoniae frequently are resistant to co-trimoxazole, the drug may not be effective in patients with AOM who fail to respond to amoxicillin. Data are limited regarding safety of repeated use of co-trimoxazole in pediatric patients GI InfectionsTreatment of travelers’ diarrhea caused by susceptible enterotoxigenic Escherichia coli. Replacement therapy with oral fluids and electrolytes may be sufficient for mild to moderate disease; those who develop diarrhea with ≥3 loose stools in an 8-hour period (especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools) may benefit from short-term anti-infectives. Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually drugs of choice when treatment indicated; co-trimoxazole also has been recommended as an alternative when fluoroquinolones cannot be used (e.g., in children). Prevention of travelers’ diarrhea† [off-label] in individuals traveling forrelatively short periods to areas where enterotoxigenic E. coli and other causative bacterial pathogens (e.g., Shigella) are known to be susceptible to the drug. CDC and others do not recommend anti-infective prophylaxis in most individuals traveling to areas of risk; the principal preventive measures are prudent dietary practices. If prophylaxis is used (e.g., in immunocompromised individuals such as those with HIV infection), a fluoroquinolone (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin) is preferred. Resistance to co-trimoxazole is common in many tropical areas.Treatment of enteritis caused by susceptible Shigella flexneri or S. sonnei when anti-infectives are indicated. Treatment of dysentery caused by enteroinvasive E. coli† [off-label] (EIEC). AAP suggests that an oral anti-infective (e.g., co-trimoxazole, azithromycin, ciprofloxacin) can be used if the causative organism is susceptible.Treatment of diarrhea caused by enterotoxigenic E. coli† [off-label] (ETEC) in travelers to resource-limited countries. Optimal therapy not established, but AAP suggests that use of co-trimoxazole, azithromycin, or ciprofloxacin be considered if diarrhea is severe or intractable and if in vitro testing indicates the causative organism is susceptible. A parenteral regimen should be used if systemic infection is suspected.Role of anti-infectives in treatment of hemorrhagic colitis caused by shiga toxin-producing E. coli† [off-label] (STEC; formerly known as enterohemorrhagic E. coli) is unclear; most experts would not recommend use of anti-infectives in children with enteritis caused by E. coli 0157:H7.Treatment of GI infections caused by Yersinia enterocolitica† or Y. pseudotuberculosis†. These infections usually are self-limited, but IDSA, AAP, and others recommend anti-infectives for severe infections, when septicemia or other invasive disease occurs, and in immunocompromised patients. Other than decreasing the duration of fecal excretion of the organism, a clinical benefit of anti-infectives in
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