Trimethoprim-Sulfamethoxazole

C difficile risk
Low
Oral Bioavailability
Excellent
Cost
IV $60/d PO $0.25/d

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

- 1 TMP/SMX DS tablet = 160 mg TMP / 800 mg SMX- 1 mL IV solution = 16 mg TMP / 80 mg SMX - 10 mL IV solution = 1 DS tab- Use total body weight in obesity- Round IV dose to nearest 80 mg TMP (5 mL)

1 DS tab PO BID

IVPO15 - 20 mg/kg/day IV of TMP component in 3 to 4 divided doses

  • For weight ~70 kg: 20 mL IV q6h 2 DS tabs PO TID - QID

IVPO15 mg/kg/day of TMP component in 3 divided doses

  • For weight ~70 kg: 20 mL IV q8h 2 DS tabs PO TID

CrCl > 30 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment required1 DS tab PO dailyNot recommended

CrCl > 30 ml/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment requiredPO: 1 DS tab PO TID - QID IV: For weight ~70 kg: 10 mL IV q6hNot recommended. If used: 5 mg/kg PO/IV q24h

CrCl > 30 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment requiredPO: 1 DS tab PO TID IV: For weight ~70 kg: 10 mL IV q8hNot recommended. If used: 5 mg/kg PO/IV q24h

Skin and Urinary InfectionsPneumocystis jirovecii InfectionStenotrophomonas InfectionNot recommendedNot recommended. If used: 5-10 mg/kg PO/IV q24hNot recommended. If used: 5-10 mg/kg IV/PO q24h

Skin or urinary infectionsPneumocystis jiroveciiStenotrophomonas infectionsNot recommendedNot recommended. If used: 5-10 mg/kg PO/IV q12hNot recommended. If used: 5-10 mg/kg PO/IV q12h

General Information

  • Urinary tract infections

  • Stenotrophomonas maltophilia infections

  • Pneumocystis Pneumonia (PCP)

  • Nocardiosis

  • Prophylaxis for PCP and Toxoplasma gondii

  • Some superficial S. aureus infections (MRSA)

  • S. aureus bacteremia (see S. aureus handbook page)

  • Enterococci are resistant (even if reported as sensitive)

  • Streptococcus pyogenes: clinical failures occur even though may be reported as susceptible

Regular monitoring of kidney function and electrolytes if:

  • Prolonged use

  • Over age 65

  • Use of ACEi or ARB

  • K sparing diuretic

  • Baseline renal injury

  • Other risks for AKI/hyperkalemia

  • Renal injury and hyperkalemia, particularly in older patients (65 or older)

  • Sudden cardiac death Higher risk in patients on angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), K sparing diuretic (e.g. spironolactone)  

  • Gastrointestinal upset common

  • Bone marrow suppression

  • Aseptic meningitis (rare)

  • Stevens Johnson syndrome/toxic epidermal necrolysis

  • Other rashes

  • ACEi and ARBs- Increased serum potassium level

  • Decreases cyclosporine

  • Methotrexate - Marrow suppression

  • Increases phenytoin

  • Increases rifampin

  • Increases INR with warfarin

Each 10 mL amp IV is equal to 1 DS Tab

Antimicrobial class: Sulfonamide - Antifolate

Pregnancy category: C

Average serum half life: 10 hours

Biliary penetration: Moderate

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic

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