Peritoneal dialysis is not effective and hemodialysis is only moderately effective in eliminating sulfamethoxazole and trimethoprim. There may be an increased risk of severe adverse reactions in elderly patients, particularly when complicating conditions exist, e.g., impaired kidney and/or liver function, possible folate deficiency, or concomitant use of other drugs. Cough, shortness of breath and pulmonary infiltrates are hypersensitivity reactions of the respiratory tract that have been reported in association with sulfonamide treatment. Blood and urine tests may be needed to check for unwanted effects. CDAD must be considered in all patients who present with diarrhea following antibiotic use. In mice following oral administration of trimethoprim, no DNA damage in Comet assays of liver, kidney, lung, spleen, or bone marrow was recorded. Respiratory: Cough, shortness of breath and pulmonary infiltrates (see WARNINGS). Patients should be counseled that antibacterial drugs including sulfamethoxazole and trimethoprim tablets should only be used to treat bacterial infections. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Bactrim (sulfamethoxazole and trimethoprim) tablets and other antibacterial drugs, Bactrim (sulfamethoxazole and trimethoprim) tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. Thrombocytopenia usually resolves within a week upon discontinuation of sulfamethoxazole/trimethoprim. Pharmacokinetics parameters for sulfamethoxazole were similar for geriatric subjects and younger adult subjects. Sulfamethoxazole and trimethoprim tablets are not indicated for prophylactic or prolonged administration in otitis media at any age. At least one clinical trial supports its use in this indication. Increased digoxin blood levels can occur with concomitant sulfamethoxazole and trimethoprim therapy, especially in elderly patients. Sulfamethoxazole and trimethoprim should be given with caution to patients with impaired renal or hepatic function, to those with possible folate deficiency (e.g., the elderly, chronic alcoholics, patients receiving anticonvulsant therapy, patients with malabsorption syndrome and patients in malnutrition states) and to those with severe allergies or bronchial asthma. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Patients with renal dysfunction, liver disease, malnutrition or those receiving high doses of sulfamethoxazole and trimethoprim are particularly at risk. Check with your doctor if you have anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness. Additional monitoring of blood glucose may be warranted. When sulfamethoxazole and trimethoprim tablets are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Just five months previously, the Japanese firm Shionogi, had registered suphamethoxazole for exactly the same purposes and licensed its use to pharmaceutical super-giant Hoffmann-La-Roche. Potential for Sulfamethoxazole and Trimethoprim to Affect Other Drugs. It is used to treat or prevent certain kinds of bacterial infections.It will not work for colds, flu, or other viral infections. Co-trimoxazole should not be given to neonates during the first 6 weeks, except for the treatment/prophylaxis of. Psychiatric: Hallucinations, depression, apathy, nervousness. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame. The following table is a guideline for the attainment of this dosage in children: For the treatment of traveler’s diarrhea, the usual adult dosage is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet or 2 sulfamethoxazole and trimethoprim single strength tablets every 12 hours for 5 days. [13], Organisms against which co-trimoxazole can be effective include:[14][15], The only notable nonsusceptible organisms are Pseudomonas aeruginosa, the mycoplasmae[15] and Francisella tularensis (the causative organism of tularaemia). Severe and symptomatic hyponatremia can occur in patients receiving sulfamethoxazole and trimethoprim, particularly for the treatment of P. jiroveci pneumonia. Clostridium difficile associated diarrhea. Talk with your doctor if you have concerns about this. Precautions. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. [2] Severe allergic reactions and Clostridium difficile diarrhea may occasionally occur. [28][29][30] Trimethoprim and sulfamethoxazole have a greater effect when given together than when given separately, because they inhibit successive steps in the folate synthesis pathway. Increased digoxin blood levels can occur with concomitant sulfamethoxazole and trimethoprim therapy, especially in elderly patients. Do not take other medicines unless they have been discussed with your doctor. The results of some tests may be affected by this medicine. No interference occurs, however, if methotrexate is measured by a radioimmunoassay (RIA). 4. These studies are further limited by recall, selection, and information biases, and by limited generalizability of their findings. [8][9], Co-trimoxazole was claimed to be more effective than either of its components individually in treating bacterial infections, although this was later disputed. Serum digoxin levels should be monitored. [2] It can be given by mouth or intravenously. When combined, TMP and SMX are bactericidal. 3. Metabolic and Nutritional: Hyperkalemia, hyponatremia (see PRECAUTIONS: Electrolyte Abnormalities). Thus the net effect of each of these drugs is a bacteriostatic halt in replication. Available for Android and iOS devices. Caution should be exercised when sulfamethoxazole and trimethoprim is administered to a nursing woman, especially when breastfeeding, jaundiced, ill, stressed, or premature infants because of the potential risk of bilirubin displacement and kernicterus. A history of mild intolerance to sulfamethoxazole and trimethoprim in AIDS patients does not appear to predict intolerance of subsequent secondary prophylaxis5. The average percentage of the dose recovered in urine from 0 to 72 hours after a single oral dose of sulfamethoxazole and trimethoprim is 84.5% for total sulfonamide and 66.8% for free trimethoprim. Mayo Clinic does not endorse companies or products. Serum digoxin levels should be monitored. Sulfamethoxazole and trimethoprim have been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section. Because sulfamethoxazole and trimethoprim may interfere with folic acid metabolism, sulfamethoxazole and trimethoprim should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. If this occurs, patients should contact their physician as soon as possible. [15], The combination of Trimethoprim with sulonamides and subsequent licensing was a purely business decision without any clinical need.[32]. Sulfamethoxazole alone was positive in an in vitro reverse mutation bacterial assay and in in vitro micronucleus assays using cultured human lymphocytes. The incidence of side effects, particularly rash, fever, leukopenia and elevated aminotransferase (transaminase) values, with sulfamethoxazole and trimethoprim therapy in AIDS patients who are being treated for P. jiroveci pneumonia has been reported to be greatly increased compared with the incidence normally associated with the use of sulfamethoxazole and trimethoprim in non-AIDS patients. Neurologic: Aseptic meningitis, convulsions, peripheral neuritis, ataxia, vertigo, tinnitus, headache. The steady-state mean plasma levels of free and total sulfamethoxazole were 57.4 mcg/mL and 68 mcg/mL, respectively. Clinical trials have confirmed its efficacy in both the treatment and prevention of malaria.