Trimethoprim/Sulfamethoxazole (TMP/SMX)

제한된
0
C. difficile 위험도
Low
경구생체이용률
Excellent

Dosing

Severe PCPTMP-based 15-20 mg/kg IV #3-4 x21d

Mild or moderate PCPUTIAECBShigellosisPCP prophylaxis- BW 48 kg TMP/SMX 240/1,200 mg PO q8h x21d

  • BW 64 kg TMP/SMX 320/1,600 mg PO q8h x21d

  • BW 80 kg TMP/SMX 400/2,000 mg PO q8h x21dTMP/SMX 160/800 mg PO q12h x10-14dTMP/SMX 160/800 mg PO q12h x10-14dTMP/SMX 160/800 mg PO q12h x5dTMP/SMX 80/400 mg PO q24h TMP/SMX 160/800 mg PO 3 times/w

Severe PCPSafety and efficacy in pediatric patients <2m of age have not been establishedTMP-based 15-20 mg/kg IV #3-4 x21d

Mild or moderate PCPUTI, acute otitis mediaShigellosis- BW 16 kg: TMP/SMX 80/400 mg PO q6h x21d

  • BW 24 kg: TMP/SMX 120/600 mg PO q6h x21d

  • BW 32 kg: TMP/SMX 160/800 mg PO q6h x21d

  • BW 40 kg: TMP/SMX 200/1,000 mg PO q6h x21d- BW 20 kg: TMP/SMX 80/400 mg PO q12h x10d

  • BW 30 kg: TMP/SMX 120/600 mg PO q12h x10d

  • BW 40 kg: TMP/SMX 160/800 mg PO q12h x10d- BW 20 kg: TMP/SMX 80/400 mg PO q12h x5d

  • BW 30 kg: TMP/SMX 120/600 mg PO q12h x5d

  • BW 40 kg: TMP/SMX 160/800 mg PO q12h x5dIf BW >40 kg, refer to adult dose.

No dose adjustment

CrCl >30CrCl 15-30CrCl <10No dose adjustment50% recommended dose at recommended intervalsAvoid

General Information

  • Urinary tract infections

  • Susceptible MRSA infections

  • Stenotrophomonas infections

  • Pneumocystis jirovecii pneumonia (treatment or prophylaxis)

Follow creatinine and electrolytes in patients at increased risk renal failure, hyperkalemia.

Perform appropriate culture and susceptibility tests before treatment.

Perform microscopic urinalysis and renal function tests during therapy, particularly in patients with renal impairment.

Monitor for acid-base disturbances and CBC.

Common

  • Rash

  • Urticaria

  • Loss of appetite

  • Nausea

  • Vomiting

Serious

  • Cardiogenic shock

  • Prolonged QT interval

  • Torsades de pointes

  • Ventricular tachycardia

  • Stevens-Johnson syndrome

  • Toxic epidermal necrolysis

  • Erythema multiforme

  • Hyponatremia

  • Agranulocytosis

  • Aplastic anemia

  • Neutropenia

  • Thrombocytopenia

  • Hepatic necrosis

  • Rhabdomyolysis

  • Clostridioides difficile infection

  • Anaphylaxis

  • ACEi - Increased serum potassium level

  • Increases amantadine levels

  • Decreases cyclosporine

  • Methotrexate - marrow suppression

  • Increases phenytoin

  • Increases rifampin

  • Warfarin - increases INR

Multiple drug-drug interactions

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

Precautions:

  • Beers Criteria: Avoid use in elderly with CrCl <15 mL/min and reduce dose if CrCl 15-29 mL/min.

  • Avoid concomitant use with phenytoin due to increased risk of phenytoin toxicity.

  • Use caution in older adults with concomitant ACEI or ARB therapy due to risk of hyperkalemia.

  • Avoid use or use caution in patients with hepatic or renal impairment.

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