Sulphamethoxazole + Trimethoprim (Co-trimoxazole)

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Generic Name of Sulphamethoxazole + Trimethoprim (Co-trimoxazole) - Learn More

Sulphamethoxazole + Trimethoprim (Co-trimoxazole)

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Precaution - What You Need to Know

Before using Sulphamethoxazole + Trimethoprim (Co-trimoxazole), patients must consult their healthcare provider due to the following precautions:

- Allergic Reactions: Co-trimoxazole may cause severe allergic reactions, including rash, fever, and more serious conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis (TEN). Any signs of allergic reactions require immediate medical attention.
- Renal Impairment: Since both sulphamethoxazole and trimethoprim are excreted by the kidneys, Co-trimoxazole should be used cautiously in patients with renal impairment. Dosing adjustments may be necessary in patients with compromised kidney function to prevent drug accumulation and toxicity.
- Hematological Disorders: Co-trimoxazole can cause blood disorders, including leukopenia, thrombocytopenia, and anemia. These can be more pronounced in individuals with a history of blood disorders or in the elderly. Regular blood count monitoring is recommended during prolonged use.
- Pregnancy and Breastfeeding: Co-trimoxazole is contraindicated during pregnancy, especially in the first trimester and near term. It can cross the placenta and may cause harm to the developing fetus. It should also be avoided during breastfeeding, as it can pass into breast milk and potentially affect the infant. Consult a healthcare provider if you are pregnant or breastfeeding.
- Folate Deficiency: Co-trimoxazole may interfere with folate metabolism, potentially worsening conditions like megaloblastic anemia. Folic acid supplementation may be necessary in patients at risk of deficiency, such as those with malnutrition or alcoholism.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Indication - Uses and Benefits

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) is primarily prescribed for:

- Urinary Tract Infections (UTIs): Co-trimoxazole is commonly used to treat urinary tract infections, including cystitis, pyelonephritis, and urethritis caused by susceptible bacteria like E. coli.
- Respiratory Infections: It is effective against respiratory infections such as bronchitis, pneumonia, and sinusitis.
- Gastrointestinal Infections: Co-trimoxazole is used in treating gastrointestinal infections, especially enteritis caused by Shigella, Salmonella, and other Gram-negative bacteria.
- Skin and Soft Tissue Infections: It can treat skin infections, including cellulitis, impetigo, and abscesses caused by susceptible organisms.
- Pneumocystis jirovecii Pneumonia (PCP): Co-trimoxazole is a first-line treatment for PCP, a severe lung infection commonly seen in HIV/AIDS patients.
- Toxoplasmosis: It is also used in combination with other agents to treat toxoplasmosis, a parasitic infection.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Contraindications - Important Warnings

Co-trimoxazole is contraindicated in the following conditions:

- Hypersensitivity to Sulfonamides or Trimethoprim: It should not be used in individuals with a history of allergic reactions to sulfonamides or trimethoprim due to the risk of severe skin reactions or anaphylaxis.
- Severe Liver or Renal Disease: It is contraindicated in patients with severe liver or kidney failure, as the drug is excreted through the kidneys, and its use can exacerbate renal toxicity.
- Blood Disorders: Co-trimoxazole should not be used in patients with a history of bone marrow suppression, megaloblastic anemia, or severe blood dyscrasias.
- Pregnancy (Especially First Trimester): It should not be used during pregnancy, especially in the first trimester, as it may cause birth defects. It should also be avoided near the term due to risks of kernicterus (a type of brain damage caused by bilirubin buildup) in the newborn.
- Neonates and Infants: Co-trimoxazole is contraindicated in newborns and infants under 2 months due to the risk of kernicterus and blood disorders.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Side Effects - What to Expect

Common side effects of Sulphamethoxazole + Trimethoprim (Co-trimoxazole) include:

- Gastrointestinal Discomfort: Nausea, vomiting, and diarrhea are common, especially when starting the medication.
- Skin Reactions: Rashes, itching, and more severe skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis (rare but serious). Photosensitivity can also occur, increasing sensitivity to sunlight.
- Blood Abnormalities: Co-trimoxazole can cause leukopenia, thrombocytopenia, or anemia. Symptoms include fatigue, pale skin, easy bruising, and frequent infections.
- Liver Toxicity: Elevated liver enzymes or hepatitis can occur in some patients. Symptoms include jaundice (yellowing of the skin or eyes) and dark urine.
- Hyperkalemia: Elevated potassium levels can cause cardiac arrhythmias. Symptoms include muscle weakness, fatigue, and palpitations.

Serious side effects (less common but severe):

- Severe Allergic Reactions: Anaphylaxis, angioedema, or serious skin reactions may occur. Seek immediate medical attention if any of these occur.
- Kernicterus in Newborns: When used near term or in infants, Co-trimoxazole can cause bilirubin encephalopathy, a life-threatening condition.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Pregnancy Category ID - Safety Information

4

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Mode of Action - How It Works

Co-trimoxazole is a combination antibiotic that works by inhibiting two crucial enzymes in the bacterial folate synthesis pathway:

- Sulphamethoxazole: Inhibits dihydropteroate synthase, preventing the formation of dihydrofolic acid, a precursor to folic acid, which bacteria need for DNA and RNA synthesis.
- Trimethoprim: Inhibits dihydrofolate reductase, which is involved in converting dihydrofolic acid into its active form, tetrahydrofolic acid. This enzyme inhibition further impedes folic acid metabolism, affecting bacterial DNA replication.

Together, these two drugs act synergistically to prevent bacterial replication and growth, making the combination bacteriostatic (inhibits bacterial growth) or bactericidal (kills bacteria) depending on the bacteria and concentration.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Drug Interactions - What to Avoid

Co-trimoxazole may interact with several drugs and substances, altering their effects or causing adverse reactions:

- Warfarin: Co-trimoxazole can increase the anticoagulant effect of warfarin, leading to an increased risk of bleeding. Regular monitoring of INR (International Normalized Ratio) levels is recommended for patients on both medications.
- Methotrexate: When used together, Co-trimoxazole can increase the toxicity of methotrexate, especially in high doses, leading to increased risk of bone marrow suppression and gastrointestinal toxicity. Caution is advised when combining these drugs.
- Diuretics: Diuretics, particularly thiazides, may increase the risk of hyperkalemia (elevated potassium levels) when used with Co-trimoxazole. Regular monitoring of potassium levels is advised.
- Phenytoin: Co-trimoxazole can increase phenytoin levels, which may enhance its toxicity. Blood tests should be conducted to monitor phenytoin levels.
- ACE Inhibitors: The combination of ACE inhibitors (such as lisinopril) and Co-trimoxazole may increase the risk of hyperkalemia.
- Oral Contraceptives: Co-trimoxazole may decrease the effectiveness of oral contraceptives, so alternative methods of contraception should be considered.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Adult Dose - Recommended Dosage

The typical adult dose of Co-trimoxazole for most infections is:

- For mild to moderate infections: 1 double-strength tablet (800 mg sulphamethoxazole + 160 mg trimethoprim) every 12 hours.
- For severe infections: 2 double-strength tablets every 12 hours.

For Pneumocystis jirovecii pneumonia (PCP), the dose is typically higher and used for an extended period.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Child Dose - Dosage for Children

In children, the dose is usually based on weight and the severity of the infection:

- For urinary tract infections or respiratory infections: 6 mg/kg trimethoprim and 30 mg/kg sulphamethoxazole daily in 2 divided doses.
- For Pneumocystis jirovecii pneumonia (PCP), the dosing is higher and may vary, with up to 20 mg/kg trimethoprim and 100 mg/kg sulphamethoxazole in divided doses.

As always, the pediatric dose should be determined by a healthcare provider to ensure safety and efficacy.

Consultation with a healthcare provider is essential before starting treatment with Co-trimoxazole to ensure the appropriate dosage and to manage any potential risks or interactions.

Sulphamethoxazole + Trimethoprim (Co-trimoxazole) Renal Dose - Dosage for Kidney Conditions

For patients with renal impairment, dosage adjustments are required:

- For creatinine clearance less than 15 mL/min, Co-trimoxazole should generally be avoided or administered at reduced doses with extended dosing intervals.
- Patients with moderate renal impairment (creatinine clearance between 15 and 30 mL/min) may require a dose reduction or monitoring to avoid drug accumulation.