BRAND NAME: Bactrim, Sulfatrim, Cotrim

GENERIC NAME: co-trimoxazole

GENERAL ACTION: anti-infectives, sulfonamides

SPECIFIC ACTION: sulfamethoxazole inhibits formation of hydrofolic acid from PABAl

teimethozoprim inhibits dihydrofolate reductase formation. Both decreases bacterial folic acid synthesis,
bactericidal.

INDICATION, DOSAGE AND ROUTE:

 Shigellosis or UTIs caused by susceptible strains of E.coli, Proteus, Klebsiella, Enterobacter

species

Adults:

160 mg trimethoprim/ 800 mg sulfamethoxazole, 1 double strength tablet, PO every 12

hours for 10-14 days in UTIs and for 5 days in shigellosis.

Children age 2 months and older:

8 mg/kg/day based on trimethoprim component PO, in two divided doses every 12 hours
for 10 days in UTIs and 5 days in shigellosis.

 Otitis media in patients with penicillin allergy or penicillin-resistant infection

 Children age 2 months and older:

8 mg/kg/day based on trimethoprim component PO, in two divided doses every 12 hours
for 10-14 days.

 Chronic bronchitis, upper respiratory tract infections

Adults:
160 mg trimethoprim and 800 mg sulfamethoxazole, PO every 12 hours for 10 -14 days.

 Traveler’s diarrhea

Adults:

160 mg trimethoprim and 800 mg sulfamethoxazole, PO every b.i.d for 3 -5 days. Some
patients may only need up to 2 days of therapy.
 To prevent pneumocystis carinii pneumonia

Adults:
160 mg trimethoprim and 800 mg sulfamethoxazole, PO daily or 80mg trimethoprim and
400 mg sulfamethoxazole PO three times weekly.

Children age 2 months and older:

150 mg/m2 trimethoprim and 750 mg/m2 sulfamethoxazole, PO daily in two divided
doses for 3 consecutive days each week.
 P. carinii pneumonia
Adults and children older than 2 months:
15 to 20 mg/kg/day based on trimethoprim PO in three or four divided doses for 14 to 21
days.

CONTRAINDICATION:

 Contraindicated in patients hypersensitive to drug or trimethroprim and sulfonamides.

 Contraindicated in those with creatinine clearance less than 15 ml/ minute, polyuria,
megaloblastic anemia from folate deficiency.

 Contraindicated in pregnant women, and infants younger than 2 months.

ADVERSE EFFECTS:

 CNS: headache, depression, seizures, tinnitus, fatigue, vertigo, insomnia, apathy, hallucinations
 CV: thrombophlebitis
 GI: Nausea, vomiting, diarrhea, abdominal pain, anorexia, stomatitis, pancreatitis,
pseudomembranous colitis
 GU: toxic nephrosis with oliguria and anuria, crystalluria, hematuria, intersititial nephritis
 Hematologic: thrombocytopenia, leucopenia, aplastic anemia, agranulocytosis, megaloblastic
anemia, hemolytic anemia
 Hepatic: jaundice, hepatic necrosis
 Muscculoskeletal: arthralgia, myalgia, muscle weakness
 Respiratory: pulmonary infiltrates
 Skin: erythema multiforme, stevens- johnsons syndrome, generalized skin eruptions, toxic
epidermal necrolysis, urticaria, photosensitivity, pruritus
 Other: hypersensitivity reactions, anaphylaxis, drug fever, serum sickness

NURSING RESPONSIBILITIES:

 Before giving drug, ask patient, if he is allergic to sulfa drugs.

 Obtain specimen for c/s before first dose.
 Double check dosage, which may be written as trimethroprim component
 Never give drug IM
 Monitor renal and liver function test result
 Promptly report rash, sore throat, fever, cough, mouth sores, or iris lesions- early s/sx of erythema
multiforme, which may lead to steven- johnsons syndrome which is sometimes fatal.
 Watch out for s/sx of superinfections such as fever, chills and increased pulse.
 Tell patient to take drug as prescribed, even if he feels better.
 Encourage patient to drink plenty of water
 Tell patient to report adverse reactions promptly
 Advise patient to avoid prolonged sun exposure, wear protective clothing, and sunscreen
 Instruct patient to take oral form with 8 ounces (240 ml) of water on an empty stomach.